












































































































































































































































































































































Class ~~^C.i c (C>9 

Boot__ 

OopigM?__ 


CCKRIGHT DEPQSffi 






* 


/ 









« 




































































































Urine 

without 

sugar 




Urine with 


V___ J 

V 

Urines with trace of sugar 


The Benedict Test for Sugar in the Urine. 


Each tube contains 5 c.c. of Benedict’s reagent and 8 drops 
of urine. The tubes have been heated for five minutes in a 
boiling water-bath and allowed to cool. (From Wilder, Foley 
and i EUithorpe, “A Primer for Diabetic Patients/’ W. B. 
Saunders Company, Publishers.) 

































DIABETES 


ITS TREATMENT BY INSULIN AND DIET 


A HANDBOOK FOR THE PATIENT 


BY 

ORLANDO H. PETTY, B.S., A.M., M.D., F.A.C.P. 

4 I 

Professor of Diseases of Metabolism, Graduate School of Medicine, 
University of Pennsylvania; Physician in Charge of Depart¬ 
ment of Metabolism, Philadelphia General Hospital; 
Physician in Charge of Department of Diabetes, 

Memorial Hospital; Visiting Physician to 
Memorial Hospital, Philadelphia, Pa. 


WITH SEVERAL ILLUSTRATIONS 



PHILADELPHIA 

F. A. DAVIS COMPANY, Publishers 

1924 


4 






~RCqos 

rP5 


COPYRIGHT, 1924 

BY 

F. A. DAVIS COMPANY 


Copyright, Great Britain. All Rights Reserved 



PRINTED IN U. S. A. 
PRESS OF 

F. A. DAVIS COMPANY 
PHILADELPHIA. PA. 


JUL -5 i924 


©C1A800070 

-ho / 





TO THE 

HON. W. FREELAND KENDRICK 

WHOSE NEVER-FAILING INTEREST IN 
THE PHYSICALLY DISABLED HAS BEEN 
A SOURCE OF ENCOURAGEMENT TO 
THE MEDICAL PROFESSION 

THIS LITTLE VOLUME IS RESPECTFULLY 
DEDICATED BY THE AUTHOR 




PREFACE 


This small volume is written for the diabetic 
patient. It defines diabetes, gives the causes, 
and also suggests methods of prevention and 
outlines in detail the calculation of foods. 

In no way is it intended as a substitute for 
the physician, but endeavors to assist him by 
giving the patient a working knowledge of a 
chronic disease that can be controlled to such a 
degree that comfort and efficiency will not be 
disturbed. 

Since this book is not a scientific discussion 
of diabetes, but a statement of facts that have 
become a matter of common knowledge among 
physicians, credit has not been given to acknowl¬ 
edged authorities for ideas which they have 
advanced. 

I am deeply indebted to my loyal and efficient 
assistants, Drs. Kenneth T. Knode and William 
M. LeFevre, for the arrangement of tables on 
food values and many other helpful suggestions. 

(5) 



6 


PREFACE. 


The section on menus and recipes was ar¬ 
ranged by two of my most competent nurses in 
diabetes, Misses Ella B. Guilfoil and Dora Russ. 
Many of the recipes are their own. 

My appreciation of the aid rendered by my 
secretaries, Miss Ann Paschall and Mrs. Wat¬ 
son, is gratefully acknowledged. 

Orlando H. Petty. 


Philadelphia, Pa. 


CONTENTS 


CHAPTER I. „ A/ .„ 

PAGE 

What is Diabetes? How Diagnosed, Its Causes and Pre¬ 
vention . 13 

CHAPTER II. 

Foods : Proximal Principles ; Inorganic Salts and Vit¬ 
amins .. 29 

CHAPTER III. 

How to Weigh and Measure Foods . 43 

CHAPTER IV. 

Method of Estimating Diet. 49 

CHAPTER V. 

How to Test the Urine for Glucose (Sugar) . 66 

CHAPTER VI. 

Insulin . 70 

CHAPTER VII. 

Technique of Administering Insulin at Home . 78 

CHAPTER VIII. 

Sample Menus . 85 

CHAPTER IX. 

Recipes . 92 

CHAPTER X. 

The Protein, Fat, and Carbohydrate Content of the 
Commonly Used Foods . 103 


( 7 ) 















FOREWORD 

By Dr. John B. Deaver, 

of Philadelphia. 


The author aptly remarks that the discovery 
of insulin has proved the unity of diabetes and 
established . . . Allen’s pre-insulin definition. 
The benefits of this epoch-making innovation in 
the control of blood sugar are particularly grati¬ 
fying to the surgeon, inasmuch as it has ef¬ 
fected so favorable a change in the aspect of 
surgery in relation to diabetes. 

The management of surgical complications of 
diabetes, or surgical conditions associated with 
diabetes, has always been a source of great con¬ 
cern to the profession. While, hitherto, certain 
dietetic and medical procedures have to a slight 
degree reduced the operative risks of this class 
of patients, it remained for the discoverer of 
insulin to brighten the prognosis of surgery in 
diabetes. In spite of its recent introduction, so 
great has been the interest aroused in this effec¬ 
tive control of hyperglycemia—for it is the in- 

(9) 


10 


FOREWORD. 


creased blood sugar with its complications that 
is the serious feature of the disease considered 
surgically—that already a voluminous literature 
has arisen on the subject. That little has ap¬ 
peared on the purely surgical aspect of the ques¬ 
tion is due to the fact that the management of 
the surgical diabetic does not materially differ 
from the treatment of the purely medical case. 
Although experience with the preoperative and 
postoperative administration of insulin to the 
diabetic has necessarily been limited, the results 
thus far are satisfactory and promise for the 
future most encouraging. The effects of opera¬ 
tion even on the non-diabetic patient very often 
produce an acidosis which also has been success¬ 
fully overcome by the use of insulin. 

Little, however, can be done without the ready 
co-operation of the internist and the surgeon. 
Co-operation between the two is desirable at 
all times, but at no time more so than in the 
management of the diabetic. The surgeon, to a 
great extent, must rely on the judgment and 
experience of the internist, who has made the 
study of diabetes and its control his own. That 
is what the author of this little volume has done. 


FOREWORD. 


11 


Its promises of usefulness are great to the pro¬ 
fession, and at the.same time its language is so 
simple and direct that it makes its appeal also 
to the general reader. 

Insulin brings the bright ray of hope to 
those who hitherto have had to be content to 
accept palliation where radical treatment, though 
indicated, was prohibitive. 




CHAPTER I. 


WHAT IS DIABETES? 

HOW DIAGNOSED, ITS CAUSE AND PREVENTION. 

Before the discovery of insulin, diabetes, even 
in medical writings, was usually defined by de¬ 
scribing its symptoms, i.e., the various com¬ 
plaints of persons suffering from diabetes. 

In 1920, Allen gave diabetes this definition: 
“Fundamentally, diabetes is deficiency of the 
internal secretion of the islands of Langerhans 
of the pancreas.” 

The discovery of insulin has proved the unity 
of diabetes and established beyond dispute 
Allen's pre-insulin definition. In a personal 
communication Allen refers to his definition 
given above and then adds the following 
thought: 

“More stress is being laid nowadays, however, 
on early diagnosis in a stage not satisfactorily 
covered by a symptomatic definition. On the 
whole, therefore, any prolonged impairment of 
carbohydrate assimilation as indicated by the 
finest alimentary and blood sugar tests is dia¬ 
betic in the great majority of instances, but we 

(13) 


14 


DIABETES. 


are not sure concerning the possible exceptions 
to this symptomatic definition.” 

The pancreas, especially since it was popular¬ 
ized by the isolation of insulin, has been de¬ 
scribed by the daily press and many non-scien- 
tific magazines as “the abdominal sweetbread/' 
also “the human sweetbread.” 

Many well informed handlers of meat and 
meat-products tell me that the pancreas is never 
sold under the name of sweetbread. 

The sweetbread which we buy at the butcher 
shop is usually the thymus gland of calves, a 
large gland situated a little above the heart and 
just beneath the breast bone. As the calf grows 
older the gland becomes smaller until it is a 
dense fibrous mass, no longer being a “sweet¬ 
bread.” The same gland is present in the child, 
similar changes taking place as the child grows 
older, becoming an adult. 

There is another sweetbread occasionally sold, 
the throat sweetbread, or the thyroid gland. 
This is the gland that is occasionally enlarged 
by disease, when it is called goiter. 

Neither the thyroid nor the thymus gland has 
any ducts to carry its secretions to the body as 
do most glands, hence these two glands are 
called ductless glands and their secretions are 
called internal secretions. 


WHAT IS DIABETES? 


15 


The pancreas is a fairly large gland (weight, 
90 grams; measurement, 6 to 8 inches long, i l / 2 
inches broad) in the abdominal cavity, immedi¬ 
ately behind the stomach. It might almost be 
called a double gland, in that it has two secre¬ 
tions, one emptying through a duct into the 
small intestine, which aids in the digestion of 
the food that passes from the stomach into the 
intestine. The other secretion of the pancreas, 
the internal secretion, comes from small glands, 
or little islands, scattered through the substance 
of the pancreas. These little islands are so 
small that they were discovered with the micro¬ 
scope by a scientist named Langerhans. The 
islands have been named the islands of Langer¬ 
hans. Their secretion, like the secretions of all 
ductless glands, passes directly through the 
walls of the ductless glands into the blood. This 
secretion is called insulin and its function is to 
change the carbohydrates (sugar) and possibly 
other foods which we eat, so that they can be 
used by the tissues of the body. 

In the normal person, the internal secretion 
of the pancreas is always large enough to take 
care of the large amount of carbohydrates 
(sugars, pastry, candies, etc.) which we eat, 
but in persons who have had an inflammation 
of the pancreas, severe enough to cripple the 


16 


DIABETES. 


islands of Langerhans, the amount of insulin 
secreted is lessened and diabetes is liable to 
develop, which disease, you will remember, we 
have already defined as “a deficiency of the in¬ 
ternal secretion of the pancreas/’ 

The severity of the diabetes depends to a 
large degree, upon the extent of the injury to 
the islands of Langerhans. Hence, the immedi¬ 
ate cause of diabetes is disease of the pancreas, 
or, as the medical man terms it, pancreatitis. 

Pancreatitis, at least in its mild form, is one 
of the most difficult of diseases to diagnose dur¬ 
ing life and is usually the result or complication 
of the following diseases: 

Gall-bladder disease, 

Peritonitis, 

Appendicitis, 

Many of the fevers, and sometimes dis¬ 
eased tonsils, teeth and ears. 

The chief causes of diabetes in which we are 
interested are the predisposing causes, because 
a person with predisposing causes can so ar¬ 
range his life that the likelihood of diabetes 
developing is remote. 

The causes which should be discussed in a 
book of this kind are heredity, intemperate eat¬ 
ing and obesity. 


WHAT IS DIABETES? 


17 


HEREDITY. 

Authorities agree that in from 20 to 25 per 
cent, of all cases of diabetes, a carefully taken 
family history reveals some ancestor of the 
patient a sufferer from diabetes. 

Since this points definitely to the inherited 
susceptibility of the pancreas to disease, one can 
readily appreciate the advisability of the descend¬ 
ant of a diabetic person following an approved 
method of prevention. 

OVEREATING. 

This is the most frequent cause of obesity. 
The obese usually consume foods containing a 
large percentage of carbohydrates as sugar, 
candies, sweets, pastries, crackers, toast, etc. 

We have explained how the pancreas must 
be severely diseased before diabetes develops. 
It is generally accepted by medical men that the 
mild cases of disease of the pancreas grow 
worse, and finally diabetes develops when strain 
is put upon the diseased pancreas by eating too 
much carbohydrates. 

The number of reported cases of diabetes 
is becoming larger every year, due, many think, 
to an increased consumption of sweets. 


18 


DIABETES. 


OBESITY. 

Life insurance companies have long recog¬ 
nized overweight as a prominent factor in pre¬ 
venting those whom they have insured from liv¬ 
ing the average number of years which they 
have estimated a healthy person should live. 

Overweight is now a definite cause for the 
rejection of applicants. There is a certain class 
of underweights who are received as A-i risks, 
but overweights are all placed in the undesirable 
or substandard class. 

These conclusions were formed after a care¬ 
ful study of the medico-actuarial statistics of 
several hundred thousand policy holders over a 
long period of years, and only the cold-blooded 
business proposition of dollars and cents influ¬ 
enced them in their studies. 

In fact, it is the combined and correlated ob¬ 
servations of many trained experts which are 
always more valuable than the individual opin¬ 
ion of any one, even that of a genius. 

The majority of cases of overweight are not 
due to lack of exercise but to improper selection 
of foods. “Eat and grow thin” is a popular 
phrase and true for most obese persons. How¬ 
ever, there are a few overweights who have 
ductless gland trouble which causes their 


WHAT IS DIABETES? 


19 


obesity. The diagnosis of ductless gland defici¬ 
ency is quite difficult and can only be dependably 
accurate when basal metabolism studies are 
made. The taking of thyroxin, or the hormone 
of other ductless glands, should always be 
checked by basal metabolism and blood-pressure 
tests. Of course, this includes supervision by 
a physician. 

The tables reproduced below are taken from 
medico-actuarial statistics of life insurance com¬ 
panies and were compiled by Fisher and Fisk in 
“How to Live,” and show definitely the danger 
of overweight. 


Influence of Overweight on Mortality. 


Ages 45 to 49 . 


Pounds overweight. 

5 . 

10 . 

20 . 

30 . 

40 . 

50 . 

60 . 

70 . 

90 . 


Per cent, higher death- 
rate than average 
for same age. 

.... 4 

.... 8 
.... 18 
.... 28 
.... 45 
.... 56 
.... 67 

.... 81 
.... 116 


Those underweight after full maturity show 
a favorable class as follows: 











20 


DIABETES. 


Ages 45 to 49 . 

Per cent, lower death- 

Pounds underweight. rate than average 

for same age. 

5 . 3 

10 . 4 

20 . 5 

30 . 3 

If this be true of the healthy, robust person, 
is it not wisdom on the part of the diabetic to 
avoid overweight? 

It is granted that there is no definite standard 
of normality. The size of the bony structures 
of the body, also the size and firmness of the 
muscles have to be considered. Even the care¬ 
ful estimation of body surface will not tell us 
the exact number of pounds we should weigh, 
yet it does not take an expert in nutrition to tell 
whether a person is poorly-nourished, well- 
nourished, or obese. This can be decided with¬ 
out measurements or tables. 

It might help you to know that the majority 
of sufferers from Bright’s disease either are, or 
have been in the past, overweight. The same is 
true in diabetes; therefore, watch your weight! 

The following tables, by Eugene L. Fisk, 
M.D., in “Health Building and Life Extension,” 
arranged according to their fuel value (calories) 
per pound are helpful if one desires to increase 
or decrease one’s weight. 






WHAT IS DIABETES? 


21 


Foods of High Fuel Value. 


Food. Fuel value per 

Food. Fuel value per 

lb. in 

calories. 

lb. in calories. 

Lard . 

.. 4086 

Entire wheat flour . 

1630 

Salt pork. 

.. 3555 

Graham flour . 

1628 

Butter . 

.. 3491 

Macaroni . 

1625 

California walnuts .... 

.. 3182 

Wheat flour (patent rol¬ 


Butternuts . 

.. 3065 

ler process) . 

1623 

Brazil nuts . 

.. 3040 

Rice. 

1620 

Black walnuts . 

.. 3001 

Bread (water rolls) .... 

1268 

Almonds . 

.. 2940 

Side of lamb. 

1263 

Pistachios . 

.. 2900 

Apple pie. 

1233 

Bacon . 

.. 2840 

Porterhouse steak . 

1230 

Chocolate. 

.. 2768 

Smoked lean ham . 

1209 

Potato chips . 

.. 2598 

Bread (white home-made) 

1199 

Peanuts . 

.. 2490 

Bread, Vienna . 

1199 

Side of pork . 

.. 2423 

Graham bread . 

1189 

Cocoa . 

.. 2258 

Average bread . 

1182 

Pineapple cheese . 

.. 2180 

Brie cheese . 

1170 

American red cheese .. 

.. 2102 

Milk bread . 

1158 

Pork sausage . 

.. 2030 

Corn meal . 

1620 

American cheese, pale . 

.. 1990 

Pearl barley . 

1615 

Doughnuts. 

.. 1941 

Chops (lamb), broiled .. 

1614 

Cream crackers . 

.. 1938 

Dried peas . 

1611 

Macaroons. 

.. 1922 

Hominy . 

1609 

Zwiebach . 

.. 1915 

Rye flour . 

1590 

Graham crackers. 

.. 1905 

Wheat flour, California 


Full cream cheese. 

.. 1890 

fine . 

1585 

Butter crackers . 

.. 1887 

Pork (chuck, ribs and 


Soda crackers . 

.. 1875 

shoulder) . 

1585 

Water crackers . 

.. 1885 

Buckwheat flour . 

1580 

Boston crackers. 

.. 1835 

Roast beef . 

1576 

Sugar . 

.. 1815 

Dried dates . 

1575 

Oatmeal . 

.. 1811 

Dried beans. 

1565 

Beef, ribs, fat. 

.. 1721 

Raisins . 

1562 

Shredded wheat. 

.. 1660 

Cow peas (dried) . 

1550 

Roquefort cheese . 

.. 1645 

Orange marmalade. 

1548 

Farina .:.. 

.. 1640 

Mutton (forequarter) .. 

1543 

Cracker wheat. 

.. 1635 

Pork chops . 

1530 

































































22 


DIABETES. 


Foods of High Fuel Value (continued) . 

Food. Fuel value per Food. Fuel value per 

lb. in calories. 

lb. in 

calories 

Neufchatel cheese . 

1484 

Breast of lamb . 

.. 1311 

Honey ... 

1481 

Salt mackerel. 

.. 1305 

Sweetened condensed milk 

1480 

Cane molasses . 

.. 1302 

Fresh ham (medium) ... 

1458 

Mince pie . 

.. 1300 

Dried Zante currants .... 

1455 

Tenderloin steak . 

.. 1290 

Beef brisket (medium fat) 

1419 

Commercial mince meat 

.. 1280 

Beef cross ribs (average) 

1440 

Lemon pie. 

.. 1156 

Mutton (hindquarter) .. 

1430 

Hindquarter fresh ham 

.. 1149 

Raisins . 

1407 

Ripe olives . 

.. 1130 

Bread (toasted) . 

1385 

Whole wheat bread ... 

.. 1113 

Lamb (forequarter) _ 

1385 

Sirloin steak . 

.. 1099 

Dried prunes . 

1368 

Fresh chestnuts . 

.. 1098 

Olives, green . 

1357 

Grape butter . 

.. 1088 

Corned beef . 

1353 

Bologna sausage. 

.. 1061 

Turkey . 

1320 

Fresh lean ham . 

.. 1042 

Smoked herring . 

1315 

Fowls . 

.. 1017 


Foods of Medium Fuel Value. 


lb. in calories. 

Olives . 995 

Beef, chuck, average .... 978 

Home-made mincemeat .. 942 

Beef, rump, lean .940 

Salmon, whole . 923 

Beef, hindquarter, lean .. 907 

Beef, sides, lean .890 

Cream . 883 

Beef, loin . 877 

Lamb, leg, roast . 876 

Pork tenderloin . 875 

Mutton, leg . 863 

Beef, ribs, lean . 845 

Beef, forequarter, lean .. 842 

Celery .840 

Beef, flank, lean . 838 


Food. Fuel value per 

lb. in calories. 


Squash pie .. 

.817 

Beef, dried, salted 

and 

smoked . 

. 817 

Veal, breast .. 

.817 

Custard pie . 

.806 

Beef, sweetbreads ... 

.799 

Beef, rib rolls, lean ., 

. 795 

Beef, neck, lean - 

. 732 

Shad, whole .. 

. 727 

Beef, tongue. 

. 717 

Veal, hindquarter .., 

.715 

Veal, side .. 

. 697 

Canned pineapples .., 

. 695 

Beef, round, lean ..., 

. 694 

Veal, forequarter ... 

. 690 

Veal, cutlet. 

.683 



















































WHAT IS DIABETES? 


23 


Foods of Medium Fuel Value {continued ). 


Food. Fuel value per 

Food. Fuel value oer 

lb. in 

calories. 

lb. 

in calories. 

Whitefish . 

... 680 

Shad roe . 

. 582 

Eggs, uncooked . 

... 672 

Salmon, dressed .... 

. 582 

Beef, fore shank, lean 

...647 

Veal liver . 

.562 

Herring, whole . 

... 644 

Sweet potatoes, raw 

. 558 

Mackerel . 

...629 

Lima beans, fresh .. 

.557 

Beef, hind shank, lean 

... 617 

Halibut steaks . 

. 550 

Green cow peas . 

... 603 

Beef, round (free 

from 

Beef, liver . 

... 584 

visible fat) .... 

.512 

Baked beans (canned) . 

...583 



Foods Low in Fuel Value. 


Cottage cheese . 

...499 

Parsnips . 

.294 

Chicken broilers . 

... 493 

Pears, fresh . 

.288 

Cod, salt . 

... 473 

Apples . 

.285 

Green corn . 

... 455 

Flounder . 

.282 

Green peas . 

,.. 454 

Apricots . 

.263 

Pomegranates . 

..447 

Blackberries . 

.262 

Bananas . 

...447 

Currants, fresh . 

.259 

Succotash, canned . 

... 444 

Peas, canned . 

.252 

Grapes . 

...437 

Raspberries, red .... 

. 247 

Cherries, canned . 

.. 407 

Celery soup, canned . 

.243 

Bluefish . 

.. 402 

Koumiss.. 

. 234 

Calf’s foot jelly . 

.. 394 

Or'anges . 

.233 

Blackfish . 

.. 393 

Pea soup, canned. 

. 232 

Plums . 

.. 383 

Oysters, fresh .. 

. 228 

Lobster, canned . 

.. 382 

Onions, fresh . 

.220 

Lobster, whole. 

.. 379 

Peaches, canned . 

. 213 

Potatoes; white, raw ... 

.. 378 

Asparagus, cooked ... 

. 213 

Cherries, fresh . 

.. 354 

Cranberries . 

. 212 

Lima beans, canned .... 

. 350 

Cod, dressed . 

.... 209 

Huckleberries . 

..336 

Squash . 

_ 209 

Oysters, canned . 

.. 328 

Beets, fresh . 

.... 209 

Haddock . 

.. 324 

Carrots, fresh . 

.... 204 

Milk, whole . 

.. 314 

Mushrooms . 

.... 204 

Raspberries, black . 

.. 300 

Lemons . 

.... 201 

Nectarines. 

.. 299 


































































24 


DIABETES. 


Foods Very Low in Fuel Value. 


Food. Fuel value per 

Food. Fuel value per 

lb. in 

calories, 

lb. in 

calories. 

Pineapples, fresh . 

...196 

Watermelons . 

... 136 

Peaches, fresh . 

... 188 

Radishes . 

... 133 

Beans, string, fresh ... 

...184 

Eggplant . 

...126 

Beets, cooked . 

...180 

Pumpkins . 

... 117 

Muskmelons . 

...180 

Spinach, fresh . 

...109 

Lemon juice . 

... 178 

Rhubarb . 

... 105 

Turnips . 

... 178 

Tomatoes, fresh . 

... 104 

Okra . 

... 172 

Tomatoes, canned . 

... 103 

Strawberries . 

... 169 

Asparagus, fresh .. 

... 100 

Milk, skimmed . 

... 167 

Beans, string, canned .. 

... 93 

Oxtail soup, canned .. 

...166 

Lettuce . 

... 87 

Buttermilk . 

... 162 

Cucumber . 

... 79 

Cabbage . 

... 143 

Vegetable soup, canned 

.. 62 

Cauliflower . 

... 139 

Consomme’, canned ... 

... 53 


Those desiring to reduce their weight should 
eat largely of the foods in medium, low, and 
very low food values, while those who are emaci¬ 
ated should eat more of the foods of high food 
value. In either case, however, large quantities 
of protein-containing foods, especially meats, 
should be avoided. 


DIAGNOSIS. 

No case of diabetes, either mild or severe, 
can be diagnosed with any degree of exactness 
without laboratory tests. 

We grant that with a patient complaining of 
several of the symptoms of diabetes it would be 
a good guess or a fairly safe wager that the 






























WHAT ft DIABETES? 


25 


patient had diabetes, but guesswork has no 
place in science and certainly should never be 
used in diagnosing or treating disease. 

A careful physical examination is indispens¬ 
able to the proper treatment of any disease, but 
by laboratory tests alone can a diagnosis of 
diabetes be positive. 

The laboratory tests necessary are the tests 
for sugar in the blood and urine. The urine 
tests are simple, and on page 67 the best method 
is described. 

All untreated diabetics have sugar in the 
urine some time during the day. This is especi¬ 
ally true with the specimen voided about two 
hours after a meal containing much carbohy¬ 
drates, or after eating a large amount of candy, 
ice cream or pastry. 

If a specimen of urine under the above con¬ 
ditions shows even a slight trace of sugar, the 
patient should accept his doctor’s advice and 
go to a hospital specially equipped to do blood 
chemistry. There a sugar tolerance test should 
be done. 

Of course, there is discomfort in going to a 
hospital breakfastless and eating 100 grams of 
glucose and having your blood tested four dif¬ 
ferent times in the four hours you must remain 
there for the test, yet the reward is great, for 


26 


DIABETES. 


without the glucose tolerance test, mild cases of 
diabetes cannot be accurately diagnosed, and it 
is only the mild cases that have any hope of 
being permanently cured. 

NORMAL BLOOD SUGAR. 

Tests for blood sugar, like nearly all physio¬ 
logical chemistry tests on the blood and body 
fluids, yield uniform results in health or disease 
only after a twelve-hour fast. 

The instructions usually given are, eat the 
usual evening meal at 6 or 7 p. m. and then eat 
nothing more until after the blood specimen is 
taken at 7 or 8 o’clock the following morning, 
thus utilizing the over-night fasting period of 
most persons. Blood sugar estimations done at 
this time show the normal range of blood sugar 
to be from 80 to 120 milligrams per 100 cubic 
centimeters of blood. 

Untreated diabetics even of only moderate 
severity usually have a fasting blood sugar above 
120 milligrams per 100 cubic centimeters of 
blood, but the potential diabetic (one likely to 
develop diabetes) and the mild diabetic are only 
detected by the glucose tolerance test, for their 
fasting blood sugars are usually within the nor¬ 
mal range. The blood of a normal person sub¬ 
jected to the glucose tolerance test rarely goes 


WHAT IS DIABETES? 


27 


above 140 milligrams per 100 cubic centimeters 
of blood, while the blood sugar of either the 
potential or the mild diabetic frequently rises 
as high as 170 to 200 milligrams per 100 cubic 
centimeters of blood. 

RENAL THRESHOLD. 

The renal threshold, or glucose threshold as 
it is sometimes termed, is the number of milli¬ 
grams of blood sugar per 100 cubic centimeters 
of blood at which sugar appears in the urine. 

The usual renal threshold (speaking of dia¬ 
betics only) is between 170 and 190 milligrams 
per 100 cubic centimeters of blood. This varies 
not only in different diabetics but also in the 
same patient. Because of this variation in renal 
threshold an occasional estimation of blood sugar 
is advised in all diabetics, for the blood sugar 
may be sufficiently high to cause gangrene or 
other complications and yet the urine be sugar 
free. 

RENAL GLYCOSURIA. 

Occasionally we find a person with a renal 
threshold so low that sugar appears in the urine, 
the blood sugar being normal, the person re¬ 
sponding to no other tests for diabetes. Such 
cases used to be called “renal diabetes” an in- 


28 


DIABETES. 


correct term and one no longer used; the cor¬ 
rect diagnosis being, renal glycosuria. 

Renal glycosuria cannot be accurately diag¬ 
nosed without the glucose tolerance test. 


CHAPTER II. 


FOODS; PROXIMAL PRINCIPLES; INORGANIC 
SALTS AND VITAMINS. 

Within the last twenty years our knowledge 
of the composition of foods and the food re¬ 
quirements of the body, in health as well as 
disease, has advanced almost ioo per cent. 

All doctors now graduated from Class A 
medical schools, and nurses who complete the 
course in first class hospitals, have a compre¬ 
hensive idea of food composition and body 
requirement. 

The diabetic owes much to the scientist who 
has analyzed foods, tested them upon animals 
and then upon man (referring especially to Dr. 
F. M. Allen for his epoch-making work on diet 
in diabetes), as well as to the brilliant Dr. 
Banting, the discoverer of insulin. I make this 
statement with the highest admiration for the 
young investigator and his dramatic success in 
isolating insulin. 

It is only within the last few years that the 
constituents of foods have received the proper 
place in the estimation of food values. It is 
now generally recognized that the elements of 

(29) 


30 


DIABETES. 


food which are necessary to body structure and 
efficiency, should be consumed in certain propor¬ 
tions to each other if we are to be in good 
health. 

Foods, generally, may be roughly divided 
into building and fuel (energy) producing 
foods. They are frequently likened to the loco¬ 
motive; the metal part of the locomotive being 
the protein of our foods and the fuel being the 
fat and carbohydrates. 

In addition to the proteins, fats and carbo¬ 
hydrates, our foods must contain minerals and 
vitamins in order to maintain a good standard 
of health or to recover from disease. 

Protein is contained in an almost pure form 
in the white of an egg; fat is represented by 
butter and oil; and carbohydrates, in pure form, 
is sugar derived from the starch of grains, fruits 
and vegetables. The minerals necessary are 
phosphorus, iron, etc.; the vitamins are acces¬ 
sory food substances which have not yet been 
isolated in pure form, but we know they are es¬ 
sential to health. / 

As indicated above, the proportion of protein, 
fat and carbohydrate in our diet is of vital im¬ 
portance. The healthy adult should have his 
daily food consumption approximately as fol¬ 
lows: 


FOODS. 


31 


Protein, io to 20 per cent.; fat, 30 to 40 per 
cent., and carbohydrate, 50 to 60 per cent. 

There is no question but that the American 
people, as a rule, eat too much protein-contain¬ 
ing foods such as meat, fish, and eggs. Eating 
more protein-containing foods than are needed 
puts an extra strain upon the kidneys, and 
causes the body tissues and fluids to contain too 
high a percentage of acids. 

The amount of protein best for the diabetic 
is the same proportion as for the normal per¬ 
son, but fats and carbohydrates must be ar¬ 
ranged in different relations, for the body of 
the diabetic cannot burn fats and carbohydrates 
as the normal person. Too much carbohydrates 
causes an excess of sugar in the body and too 
much fat causes acidosis to develop. A safe 
proportion for the diabetic is, 1 gram of carbo¬ 
hydrate to 3 grams of fat. On page 53 the 
method of counting these proportions is given. 

The mineral requirements of food for the nor¬ 
mal and diabetic person is the same, and a diet 
properly balanced in the other constituents sup¬ 
plies all the minerals needed. 

Vitamins are not present in all foods. The 
process of manufacturing the prepared foods, 
also the cooking of the majority of foods de¬ 
stroy the vitamins. Therefore, we must attend 


32 


DIABETES. 


more closely to vitamins than we do to the 
minerals in our foods. There are at least three 
vitamins, named in this manner: 


.Fat soluble A 

Water soluble B. 

.Water soluble C 


Each has a definite, established influence upon 
the health of our bodies, and in some diseases 
will cure the disease. 

TABLES SHOWING FOOD CONTAINING 
VITAMINS.* 

Foods containing the three vitamins in pro¬ 
tective quantity: 

Fat soluble A; Water soluble B; Water soluble C. 
Tomatoes (canned and fresh) Turnips 

Cabbage (fresh, raw) Lettuce 

Carrots Milk 

Cauliflower Liver 

Peas (fresh) 

Spinach 

Foods containing chiefly growth-promoting 
vitamin: 


Fat Soluble A. 


Butter 

Cream 


Herring 
Cheese 
Egg yolks 


Codliver oil 
Salmon 


* From “Health Building and Life Extension.” 






FOODS. 


33 


The preceding tables reproduced from “Health 
Building and Life Extension/' by Eugene Lyman 
Fisk, M.D., give the commonly used available 
foods and also indicate their specific values. 

The chief vitamin constituent of orange, 
lemon and tomato is water soluble C and is 
not destroyed by heating, their acid content 
preventing its destruction. 

The water soluble C in cabbage is destroyed 
by heat, hence, must be eaten raw, if its vita¬ 
min aid is desired. 

The presence of vitamins in foods can only 
be decided by tests upon animals and is a diffi¬ 
cult, tedious task. 

Dr. Fisk states on page 194: 

“Adults who are proper subjects for vitamin 
treatment should try forced feeding with foods 
rich in the water soluble B vitamin. If this 
fails, then the counsel of a physician should be 
taken as to the use of any specially prepared 
vitamin. Unfortunately, it is a very difficult 
matter to test the activity of such preparations. 
This can only be done by animal experimenta¬ 
tion. A number of commercial preparations 
have been found to be practically inert, although 
there is no reason why an actual preparation of 
water soluble B, or yeast extract, should not be 
made. Hence, the need for caution on the part 
3 


34 


DIABETES. 


of the public in using these preparations. A 
vitamin preparation that contains drugs is simply 
a patent medicine and should be strictly avoided. 
In improving the so-called average individual, 
his education in the matter of wider use of vita¬ 
min-bearing foods should not be overlooked, nor 
the need of thorough physical examination, be¬ 
fore experimenting unsupervised with any of 
these widely heralded panaceas for human ills.” 

Water is a very important food; approxi¬ 
mately 60 per cent, of our body weight being 
water. It is generally accepted that the adult 
requires about 3000 mils of water in 24 hours. 
Our foods supply about 2200 mils of water, so 
we should drink 5 or 6 glasses (750 or 800 mils) 
daily. A cup of coffee or any liquid food re¬ 
places an equal amount of water. 

Another essential part of the daily food sup¬ 
ply is cellulose or the coarse part of vegetables 
and grains. 

Nowadays, constipation is treated and cured 
in the great majority of cases by eating foods 
containing a large proportion of coarse ele¬ 
ments, commonly called “roughage.” 

Certain elements of food are of value in treat¬ 
ing diabetes when complicated by kidney dis¬ 
ease, high blood-pressure and some forms of 
“indigestion.” Tables to meet special require- 


FOODS. 


35 


ments and to assist you in following your 
physician's instructions are added. You will 
note that some foods form acids and the other 
foods form base or alkali and that the final ef¬ 
fect upon the cells of the body is not always 
according to their taste or reaction when eaten. 

An example is oranges which are acid when 
eaten but alkaline in their action upon the body 
cells. A careful study of these tables of Sher¬ 
man and Gettler will correct many false ideas 
about “acid foods.” 

The “uric acid” theory was presented before 
Sherman and Gettler’s scientific study of the final 
action of foods, yet it was never accepted by 
scientific men. The advance in the knowledge 
of foods has placed the term “uric acid diathesis” 
among the obsolete phrases. 


36 


DIABETES. 


DIET TABLE SHOWING EXCESS OF ACID¬ 
FORMING OR BASE-FORMING ELEMENTS.* 


Articles of food. 


Almonds . 

Almonds . 

Apples . 

Asparagus . 

Bananas . 

Beans, dried . 

Beans, dried . 

Beans, lima, dried 

Beets. 

Cabbage . 

Cabbage . 

Carrots . 

Cauliflower . 

Celery . 

Cherry juice. 

Chestnuts. 

Corn, sweet, dried 

Crackers . 

Currants, dried ... 

Eel . 

Eggs . 

Egg white . 

Egg yolk . 

Fish, haddock. 

Fish, pike . 

Lemons . 

Lettuce . 

Meat, beef, lean .. 
Meat, beef, lean .. 


EXCESS ACID OR BASE IN TERMS OF NORMAL 
SOLUTION. 


Acid. 


c.c. 


5.95 

7.81 


9.89 

11.10 

5.24 

26.69 

16.07 

11.81 


13.91 

10.05 


O grams. 

Per 100 calories. 

Base. 

Acid. 

Base. 

C.C. 

C.C. 

C.C. 

12.38 


1.86 

11.76 


1.76 

3.76 


5.98 

0.81 


3.65 

5.56 


5.62 

23.87 


6.92 

11.58 


3.36 

41.65 


12.08 

10.86 


23.57 

4.34 


13.76 

7.10 


22.51 

10.82 


23.91 

5.33 


17.48 

7.78 


42.17 

4.40 



7.42 


3.19 


1.77 



1.95 


5.97 


1.85 


7.55 



9.52 



7.08 








5.45 


12.32 

7.37 


38.69 


12.10 


. 

8.74 



* H. C. Sherman and A. O. Gettler. 


















































































FOODS. 


37 



EXCESS ACID OR BASE IN TERMS OF NORMAL 
SOLUTION. 

Articles of food. 

Per 100 grams. 

Per 100 calories. 


Acid. 

Base. 

Acid. 

Base. 

Meat, beef, lean . 

C.C. 

12.00 

C.C. 

C.C. 

10.44 

C.C. 

Meat, beef, lean 

13.67 


11.89 


Meat, chicken . 

17.01 



Meat, frog . 

10.36 




Meat, pork, lean . 

11.87 




Meat, rabbit , 

14.80 




Meat, veal . . , 

13.52 




Meat, venison . 

15.83 




Milk, cow's . 

2.37 


3.44 

Milk, cow’s . 


1.26 


1.83 

Muskmelon . 


7.47 


18.82 

Oatmeal . 

12.93 

3.23 

Oatmeal . 

10.63 


2.66 


Oranges . 

5.61 

10.94 

Peaches . 


5.04 


12.20 

Peanuts . 

3.9 

0.70 

Peas, dried . 

7.07 

1.98 

Peas, dried . ... 


3.36 


0.94 

Potatoes 1 


7.19 


8.63 

Potatoes 2 . 


5.5 


Potatoes 


7.72 


9.26 

Prunes . 


24.40 


8.05 

8.43 

Prunes . 


25.55 


Radishes .... 


2.87 


• 9.79 

Raisins . 


23.68 


6.87 

Raspberry juice 


4.91 


Rice 1 . 

8.1 

3.35 


Rice 2 . 

7.08 


2.05 


Rice. 

8.35 


2.42 


Turnips . 

2.68 

6.86 

Turnips . 


6.80 


9.41 

Wheat, entire . 

9.66 

3.25 

Wheat, entire . 

12.39 


3.47 


Wheat, flour. 

11.61 

. 

2.70 






























































































38 


DIABETES. 


Dr. Frederick M. Allen has recently demon¬ 
strated the value of a salt-free diet in treating 
high blood-pressure, regardless of its cause. I 
have found this diet a great help in reducing the 
elevated blood-pressure of diabetics with this 
complication. 

It is very difficult to adhere to a salt-free diet 
at home and it should neither be undertaken nor 
continued without the supervision of a physician. 
I include the “Table of Natural Salt Content 
of Food,” as compiled by Dr. Allen: 

FRESH VEGETABLES. 


Artichokes . 

Asparagus .066 

Beans, butter .015 

Beans, lima .015 

Beans, string.040 

Beets .98 

Breadfruit .17 

Brussels sprouts .068 

Cabbage .04 

Carrots .061 

CaulifldWer .085 

Celery ... .265 

Cucumbers.168 

Dandelions .168 

Eggplant .041 

Endive.2 73 

Kohl rabi .090 

Leeks . .041 

Lettuce .125 

Mushrooms .036 

Okra . 

Onions.036 


Parsnips .051 

Peas .040 

Potatoes .065 

Potatoes, sweet.160 

Pumpkin . 

Spinach .125 

Tomatoes .057 

Tomato juice .094 

Turnips .070 

Water cress.100 

Chard .:>.... .066 

Pepper, green .022 

Corn . 024 

Apples .008 

Apricots .003 

Bananas .210 

Blackberries .017 

Blueberries .013 

Canteloupes .070 

Cherries .024 

Cranberries .015 

Currants . 010 














































FOODS. 


39 


BERRIES AND FRUITS 
(FRESH). 


Figs .024 

Grapes .008 

Grapefruit .008 

Huckleberries .013 

Lemon .003 

Muskmelon .070 

Oranges .010 

Peaches.006 

Pears .018 


Pineapple .086 

Plum .003 

Pomegranates .005 

Prunes . 

Raspberries, red. 

Raspberries, black. 

Strawberries .010 

Watermelon .013 


VEGETABLES, DRIED. 


Beans, kidney 

.070 

Corn, sweet . 

... .085 

Beans, lima .. 

.119 

Lentils . 

... .085 

Beans . 

.054 

Peas . 

... .060 


PICKLES AND CONDIMENTS. 


Horseradish . 

.027 

Olives . 

... .006 

Mustard . 

.027 

Paprika . 

... .263 


CEREALS, FLOUR, ETC. 


Macaroni .... 

.124 

Shredded wheat . 


Oatmeal . 

.117 

Tapioca . 

... .033' 

Rice, brown .. 


Wheat flour . 

... .126 

Rice, white ... 

.092 

Whole wheat flour .. 

... .119 

Rice, flour ... 


Wheat bran . 

... .153 

Rye . 

.093 




FRUIT 

JUICES. 


u 

005 

Lime . 


Currant . 

.008 

Orange . 

... .005 


003 

Pear. 


Lemon . 

.013 

Raspberry . 















































40 


DIABETES. 


FRUIT, DRIED. 


Apples . 

.042 

Dates . 

.290 

Apricots . 

.015 

Figs . 

...073 

Citron . 

.005 

Prunes . 

.029 

Currants . 

. 100 

Raisins . 

.140 


SUGARS. 


Honey . 

.050 

Maple Syrup . 

.017 

Jelly . 

.007 

Molasses . 

.536 


EGGS. 


Egg, white. 

.274 

Egg, whole . 

.180 

Egg, yolk. 

.160 




MISCELLANEOUS. 


Vinegar, cider ... 

.049 

Cider . 

. 010 

Beer . 

. 010 

Cocoa . 

.051 

Blood . 

.475 

Wine . 

.019 

Chocolates . 

.086 




MEATS, FISH, ETC. 


Meat per 100 Gms. protein .642 
Fish “ “ “ “ .896 

Caviar “ “ “ “ 3.090 

Clams, round, per 100 Gms. 
protein.2.040 


Clams, long, per 100 Gms. 


protein.1.54 

Oysters .1.00 

Shrimp .. 

Truffles .066 


NUTS. 


Almonds .063 

Beech nuts. 

Brazil nuts . 

Chestnuts .104 

Cocoanuts, fresh .204 


Cocoanuts, dried .400 

Hazel nuts .113 

Peanuts .095 

Pecans .085 

Walnuts .068 







































FOODS. 


41 


CEREALS, FLOUR, ETC. 


Barley, entire . 

.027 

Farina . 

.129' 

Barley, pearl . 

. .027 

Flaxseed . 

.037 

Barley flour . 


Graham flour . 

.119 

Buckwheat . 

.020 

Hominy. 

.078 

Cornmeal . 

.246 




BREAD, CRACKERS. 


Boston brown bread 

.1.030 

Rye . 

.1.743 

Entire wheat bread 

.1.030 

Wheat . 

.1.030 

Graham crackers . 

.1.030 

Crackers . 

.1.540 


SALT FREE DIET. 

Sodium Chloride—Table Salt. 

Sodium Bicarbonate—Baking Soda. 

Avoid these salts in all forms— 
a—On the table, 
b—In preparation of food, 
c—In purchase of foods, canned vegetables, 
dried and salted foods and all foods 
where doubtful as to salt content, 
d—As far as possible use those foods the 
salt content of which is low. See salt 
list. 

These restrictions will mean the entire elim¬ 
ination of milk from the diet on account of its 
high salt content. Use cream diluted if neces¬ 
sary. Also avoid baking soda and baking pow¬ 
der as leavening agents. Use only yeast or 
eggs—bread, sponge cake, meringues. 
















42 


DIABETES. 


LOW CALORIE DIET. 

Excess carbohydrate and fat are stored in 
the body as fat. Protein cannot be stored. It 
is continually broken down. Therefore meats, 
fish, fowl and eggs may be used in greater 
amounts. With reference to food value tables, 
use foods with low carbohydrate and low fat 
content. Avoid all rich, heavy foods, i.e. } rich 
desserts, pastries, cereals, sweets, fat meats, 
oil, butter, etc. Omit breadstuffs. 


CHAPTER III. 

HOW TO WEIGH AND MEASURE FOODS. 

The treatment of diabetes is no longer theor¬ 
etical, but is based upon observation and experi¬ 
ment. We know the essential elements of food 
and their end products after they are burned up 
in the body, and can estimate approximately 
the poisonous substances that certain proportions 
of food elements will produce, especially in dia¬ 
betics. If the food a diabetic consumes is ac¬ 
curately weighed as the physician has directed, 
the danger of poisonous end products— i.e., 
acidosis—is practically eliminated. 

The easiest way to estimate quantities of food, 
either liquids or solids, is by the metric system. 
The metric system has been legalized in many 
nations and is the accepted standard among the 
scientific men of the world. Our monetary sys¬ 
tem is founded upon it and, if you start with it, 
you will find you can estimate your meals as 
easily as you can count dollars and cents in our 
money. It is a much better way than the sys¬ 
tem used in the majority of stores selling food¬ 
stuffs in the United States. 


(43) 


44 


DIABETES. 


The basis of the metric system is the unit of 
length, the meter, and this is one forty-millionth 
part of the circumference of the earth at its 
poles. 

The liter, the unit of capacity, is the cube of 
one-tenth part of a meter. 

The gram is the one-thousandth of the weight 
of a liter of distilled water at its greatest density. 

In estimating diabetic foods, we use the gram 
and the liter. The unit of weight, the gram, is 
so small that it is not necessary to employ its 
subdivisions, the milli, centi and the deci-gram. 
The unit of capacity, the liter, is much larger, 
so we use the term “mil”, a shortening of milli¬ 
liter (the commonly used unit of measure in 
measuring liquids), which is one one-thousandth 
of a liter. A mil was originally called a cubic 
centimeter or a c.c., but now measures of capac¬ 
ity, including syringes, are being marked with 
the term “mil.” 

The following table gives an idea of the rela¬ 
tion of the units of measurement in the metric 
system, but only the italicized ones are the ones 
a diabetic will use: 

METRIC TABLE OF CAPACITIES. 

10 millilitres make one centilitre 
10 centilitres make one decilitre 
10 decilitres make one Litre 


HOW TO WEIGH AND MEASURE FOODS. 45 


METRIC TABLE OF WEIGHTS. 

10 milligrams make one centigram 
10 centigrams make one decigram 
10 decigrams make one gram (Gm.) 
10 grams make one dekagram 
10 dekagrams make one hectogram 
10 hectograms make one kilogram 



Fig. 1.—Food scale with movable disk. 

(John Chatillon & Sons, N. Y.) 

Scales for weighing your food are marked in 
grams and are not expensive. The majority of 
large scales upon which you weigh yourself 
still use the old system of pounds and ounces. 
Yet the scientific papers discussing body weight 
refer to kilograms instead of pounds. A kilo¬ 
gram, or “kilo”, as it is generally called, is two 
and two-tenths (2.2) pounds. This term, how- 










Fig. 2.—Collapsible traveling food scale ready for use. 
(John Chatillon & Sons, N. Y.) 


( 46 ) 









HOW TO WEIGH AND MEASURE FOODS. 47 

ever, you will never use in weighing your foods, 
but I have explained it so you will understand 
the language of the scientist when he refers to 
a patient’s weight as being so many kilos. 



Fig. 3.—Collapsible traveling food scale partially closed 
after using. (John Chatillon & Sons, N. Y.) 


The type of scale we advise all our diabetics 
to purchase is shown on page 45. It has a 
movable disk so the dish to contain the food is 
placed upon the scale platform, then the 0 on 






48 


DIABETES. 


the disk is turned to the arrow point. Food is 
then put in the dish until the arrow points to 
the number of grams which you are to use, the 
dish from which you are to eat your food taking 
the place of the scale pan you see in use in the 
grocery stores. 

The scientifically accurate way of measuring 
liquids is in a vessel marked in mils. However, 
since one mil of water weighs one gram, and 
the ordinary liquids used by a diabetic vary 
little from the weight of water, you can weigh 
your liquids in an ordinary drinking glass or 
cup upon your metric system scales in grams. 
For practical purposes in measuring liquids the 
gram and mil are interchangeable. 

It will be a help to you to understand one 
other unit of food value, the calorie. This 
unit of food value expresses the amount of 
energy or heat produced by a certain amount 
of food, a calorie being the amount of heat re¬ 
quired to raise the temperature of one liter of 
water from 0 Centigrade to i degree Centi¬ 
grade. The Centigrade thermometer is used 
to measure heat in the metric system and is 
graduated from 0, the temperature of freez¬ 
ing water, to ioo, the temperature of boiling 
water. 


CHAPTER IV. 


METHOD OF ESTIMATING DIET. 

In Chapter III you have learned something 
of food and how much the average healthy per¬ 
son needs. The diabetic can eat every kind— 
note carefully that I did not say the same 
amount, but every kind —of food that a normal 
person can eat except sugars, candies and 
pastries. 

Prior to the discovery of insulin, the person 
who had diabetes in a severe form had to have 
his food limited in amount to such a degree that 
he grew weak from being so thin and many such 
patients could not earn a livelihood. But with 
insulin we can keep even the most severe dia¬ 
betic strong enough to continue his usual work. 

If a diabetic is to be free from the ill effects of 
the disease, work and enjoy life, he must learn 
to count the total amount of food he can safely 
eat in 24 hours, and to accurately divide this 
among his three meals, using 3 or 6 per cent, 
and 15 or 20 per cent, vegetables, as well as 
fruits, berries, melons and even cereals. 

The more a patient knows about composition 
and food values the wider range of food he will 
4 (49) 


50 


DIABETES. 


have and the better health he will enjoy at the 
same time. In fact, since insulin, is- available 
for the more severe cases, if the patient thor¬ 
oughly masters the diet problems for diabetes, 
and follows his particular diet faithfully, he 
can consider his diabetes practically cured. 

The first step is an approximate estimate of 
the amount of food that you require. This ap¬ 
proximate estimate is used when you first enter 
the hospital and is gradually increased or dim¬ 
inished until we find the amount of food your 
special case requires to keep you well nourished, 
strong, and safe from the dangers of diabetes. 

The most accurate tables and measurements 
of our best physiologists cannot estimate the in¬ 
dividual differences in metabolism (“constitu¬ 
tion,^” as I called it before I studied medicine) 
of healthy people, much less those influenced by 
disease; hence, it is necessary to start each case 
on an approximate standard and then change it 
from day to day until it suits the special “con¬ 
stitution.” 

The following is one of the methods I use: 
During the thorough physical examination which 
every patient should receive before treatment 
is begun, your weight and height is accurately 
taken, the “Ideal Build” table from “How to 
Live,” by Fisher and Fisk, is consulted, your 


METHOD OF ESTIMATING DIET. 


51 


ideal weight estimated and io pounds subtracted 
from the ideal weight, as it is generally accepted 
that a diabetic should be io pounds under ideal 
weight. Then, if your daily life is of the aver¬ 
age activity, we allow you to start with 30 cal¬ 
ories per kilogram of body weight. 

THE IDEAL BUILD. 

(Weight at age 30 for various heights.) 


Men. Women. 


5 ft. 


. 126 

lbs. 

4 

ft. 

8 

in. 

..112 lbs. 

5 ft. 

1 in. 

. 128 

lbs. 

4 

ft. 

9 

in. 

..114 lbs. 

5 ft. 

2 in. 

. 130 

lbs. 

4 

ft. 

10 

in. 

..116 lbs. 

5 ft. 

3 in. 

. 133 

lbs. 

4 

ft. 

11 

in. 

..118 lbs. 

5 ft. 

4 in. 

. 136 

lbs. 

5 

ft. 



.. 120 lbs. 

5 ft. 

5 in. 

. 140 

lbs. 

5 

ft. 

1 

in. 

.. 122 lbs. 

5 ft. 

6 in. 

. 144 

lbs. 

5 

ft. 

2 

in. 

.. 124 lbs. 

5 ft. 

7 in. 

. 148 

lbs. 

5 

ft. 

3 

in. 

.. 127 lbs. 

5 ft. 

8 in. 

. 152 

lbs. 

5 

ft. 

4 

in. 

.. 131 lbs. 

5 ft. 

9 in. 

. 156 

lbs. 

5 

ft. 

5 

in. 

.. 134 lbs. 

5 ft. 

10 in. 

. 161 

lbs. 

5 

ft. 

6 

in. 

.. 138 lbs. 

5 ft. 

11 in. 

. 166 

lbs. 

5 

ft. 

7 

in. 

.. 142 lbs. 

6 ft. 


. 172 

lbs. 

5 

ft. 

8 

in. 

.. 146 lbs. 

6 ft. 

1 in. 

. 178 

lbs. 

5 

ft. 

9 

in. 

.. 150 lbs. 

6 ft. 

2 in. 

. 184 

lbs. 

5 

ft. 

10 

in. 


6 ft. 

3 in. 

. 190 

lbs. 

5 

ft. 

11 

in. 

.. 157 lbs. 

6 ft. 

4 in. 

. 196 

lbs. 

6 

ft. 



.. 161 lbs. 

6 ft. 

5 in. 

.201 

lbs. 






The above tables 

show 

the 

optimum 

or best 


weight condition for the average adult at any 
age. Insurance experience has shown that 
people conforming most closely to this build, 






































52 


DIABETES. 


which is attained at full maturity, have the low¬ 
est death rate. 

The gain in weight with advancing years, be¬ 
yond age 35 , is not physiological, but a physical 
handicap attended by a higher death, rate than 
obtains among people who do not show such an 
increase. That is, a youthful figure as a rule 
reflects a superior vitality, other things being 
equal. Some allowance, of course, must be made 
for the physical type of the individual. We rec¬ 
ognize three main types: First, those with slen¬ 
der framework; second, those with medium 
framework; and third, those with massive frame¬ 
work. 

While no hard and fast lines can be drawn, 
in a general way it may be stated that the slen¬ 
der type may be allowed a reduction of io per 
cent, from the above tables and still be healthy 
and resistant, although even this type should 
guard against extreme light weight. 

The medium type would do well to keep as 
close to the above table as possible. 

The massive type may be allowed io to 15 
per cent, increase over the above table, but should 
still regulate jthe diet and activities to combat 
any tendency to increase in weight. 

Bear in mind that while life insurance com¬ 
panies have been successful in selecting a favor- 


METHOD OF ESTIMATING DIET. 53 

able class of light weights, they have not been 
successful in finding a favorable class of heavy 
weights, that is, regardless of type, there is a 
certain extra death-rate in any over-weight 
group. The death rate is higher if the over¬ 
weight is obviously fat, as in cases with exces¬ 
sive girth. 

The chest measurement should equal at least 
half the height, and the girth at the waist line 
should not exceed the chest measurement. 

These tables are based upon the weight taken 
as in a life insurance examination, with coat and 
vest removed and height taken with shoes on. 

Suppose your ideal weight were 120 pounds. 
Divide this by 2.2 (the number of pounds in a 
kilogram), which results in approximately 60 
kilograms, multiplied by 30 equals 1800 calories, 
or your total daily amount of food. Now pro¬ 
ceed to divide the 1800 calories of food among 
proteins, fats, and carbohydrates. 

The usual estimate of protein per kilogram 
of body weight for an adult diabetic is 0.6 to 1 
gram (growing children 1.5 to 2 grams). In 
this illustration we will use one gram per kilo¬ 
gram of body weight; hence, this 130-pound 
patient will receive 60 grams of protein. From 
the chapter on food values, we learned that 1 
gram of protein contains 4 calories, hence, 240 


54 


DIABETES. 


of these 1800 calories would be supplied by pro¬ 
tein, leaving 1560 calories for carbohydrates 
and fats. 

One gram of carbohydrates to 3 grams of 
fats is the safe proportion for a diabetic. To 
continue the calculation, reduce the grams to 
calories, as follows: 


Carbohydrates ... 1 gram equals 4 calories 
Fat . 1 gram equals 9 calories 


Then, since the estimated proportion of car¬ 
bohydrates to fats in grams is 1 to 3, the pro¬ 
portion of carbohydrates to fats in calories would 
be 4 to 27, or a total of 31. The calories re¬ 
maining, after deducting the protein calories, 
1560, divided by 31, equals 50.2, the number of 
grams of carbohydrates in this patient's diet. 
For the fats, 50 times 3, as the proportion of 
carbohydrates to fats is 1 to 3, or 150 grams, for 
the fats in this patient’s diet. This is the short 
method. 

So this patient’s estimated diet would contain: 

Protein. . 60 grams 

Fat . 150 grams 

Carbohydrates . 50 grams 

these amounts of food containing a little less 

than 1800 calories, (exactly 1790 calories), 
which is calculated as follows: 






METHOD OF ESTIMATING DIET. 


55 


Protein . 60X4 equals 240 calories 

Fat . 150 X 9 equals 1350 calories 


Carbohydrates .... 50 X 4 equals 200 calories 

Total. 1790 calories 

Example in proportion: 

Weight 130 pounds; 60 kilograms; 1800 calories. 

1 gram of protein to one kilo, of body weight. 
Protein proportion would then be 60 grams or 240 
calories. 

1800 calories minus 240 calories leaves 1500 calories 
remaining for fats and carbohydrates. 

Reduce the grams to calories as follows: 


Carbohydrates ... 1 gram equals 4 calories 
Fat . 1 gram equals 9 calories 


Proportion: 

1 :3 or in calories 4:27 or a total of 31. 

4:31 :: x : 1560. 

31x equals 1560 times 4 or 6240. 

x equals 201 or the number of calories of the 
carbohydrate. 

201 ~ 4 (calories per gram of carbohydrate) 
equals 50 grams of carbohydrate. 

1560 — 201 equals 1359 (the number of calories 
of fat). 

1359-—9 (the number of calories per gram of 
fat) equals 151 or the number of grams of fat. 

Approximate proportion: 

Protein 60; Fat 150; Carbohydrate 50. 






56 


DIABETES. 


DIAGRAM 1 


Fat 


Carbohydrates 


Prot ein 


Total 

Glucose 


I 



Fatty 

Acids 


The above diagram showing the relation of 
the total glucose to the total fatty acids will 
help to clarify the problem of fats and other 
acidosis-producing bodies in the diabetic’s food. 

At the top of the diagram are the words 
“Protein,” “Fat,” and “Carbohydrates;” below 
this, to the left, “Glucose;” to the right, “Fatty 
Acids.” 

Since 58 per cent, of the protein yields prote¬ 
oses, which is converted to glucose, the remain¬ 
ing 42 per cent, being fatty acids, this division 
is indicated by a line going to “glucose” and an¬ 
other to “fatty acids.” 

Of the fat, 10 per cent, is glyceroles which are 
converted to glucose and 90 per cent, is fatty 
acids—hence, the two lines from “Fat.” 

As all of the carbohydrates, or 100 per cent., 
are converted into glucose, one line is drawn 
from “carbohydrates” leading, of course, to 
“glucose.” 


METHOD OF ESTIMATING DIET. 


5 7 


DIAGRAM 2 



Fatty 

Acids 


The practical use of the total glucose to fatty 
acid ratio is indicated in the second diagram in 
which we use the supposed 130-pound diabetic 
patient with the amounts, previously estimated, 
of protein (60), fat (150), carbohydrate (50). 

Should this diet contain 99.8 grams of glu¬ 
cose and 160.2 grams of fatty acid, there exists 
a total glucose to fatty acid ratio of 99.8 to 

. 160.2 _ , . 

160.2 or-- =1.6; that is, a ratio of 1: 1.6. 

99.8 

It is probably not safe to have this ratio of 
total glucose to fatty acid in your day’s food 
higher than one part of glucose to two parts of 
fatty acid, although there are some diabetics 
who can keep in good health and eat foods with 
a higher proportion. 

The amount of protein, fat, and carbohydrates 
in each meal is very important and you must 
not change any of them without the advice of 
your physician. It is best for those inconveni- 



58 


DIABETES. 


enced by diabetes to adhere absolutely to the 
rule, letting the other fellow do the experiment¬ 
ing. Many persons, when they are sick, keep 
away from the physician who has the reputa¬ 
tion of experimenting upon his patients, yet 
some diabetics would not hesitate to change the 
units of their food without their physician’s 
advice, thus performing upon themselves experi¬ 
ments that are much more dangerous than the 
experimental methods of the doctor who is 
especially trained in this work. 

In Chapter X, the common vegetables, fruits, 
nuts, etc., are arranged in the different columns 
according to the percentage of carbohydrates 
they contain, being roughly divided into 3, 6, 
15, 20 and 30 per cent, foods. Also another 
group showing the protein, fat and carbohy¬ 
drates and total calories in 100 grams of the 
most frequently used foods. 

The percentage method in counting carbo¬ 
hydrates when the metric system is used is 
exactly according to the principle as we figure 
per cent, in estimating the per cent, of interest 
in U. S. money. For example: If $3.00 is the 
amount of money you received for having loaned 
some money at 3 per cent., it would be a very 
simple question in arithmetic to estimate the sum 
of money you had loaned; viz.: $3.00 divided by 


METHOD OF ESTIMATING DIET. 59 

3 equals $1.00. Then $1.00 X ioo equals $100.00, 
or the total amount loaned. 

We started our illustration with a patient 
weighing 60 kilograms (130 pounds) and esti¬ 
mated his daily diet to be protein 60, fat 150, 
carbohydrate 50. So we will estimate his daily 
carbohydrates first and learn how much 3 per 
cent, vegetables it takes to make 50 grams of 
carbohydrates. 50-^3 equals 16.666; then 
16.67 X 100 equals 1667 grams of 3 per cent, 
vegetables. This amount you can. divide among 
whichever of the vegetables in the 3 per cent, 
list you desire—as 400 grams of asparagus, 600 
grams of cauliflower, 200 grams of eggplant, 
and 467 grams of tomatoes; or any other com¬ 
bination of the 3 per cent, vegetables that equals 
1667 grams. If you prefer to use all of your 
carbohydrates in the form of 6 per cent, vege¬ 
tables, you would count it out this way: 

50 H- 6 = 8.333, then 8.333 X 100 = 833 
grams of 6 per cent, vegetables and. this could 
include 300 grams of canned peas, 200 grams of 
pumpkin and 333 grams of beets, or any other 
combination of the 6 per cent, vegetables that 
made 833 grams. 

The same method of counting is used in es¬ 
timating the amount of 15 or 20 per cent 
vegetables. 


60 


DIABETES. 


We will use the 20 per cent, vegetable, this 
time consuming all his 50 grams of carbohy¬ 
drates in this per cent, group. 

50 -r- 20 = 2.5; 2.5 X 100 = 250 grams of 20 
per cent, vegetables. 

From these calculations you have observed 
that the higher the percentage of carbohydrates 
in the food taken, the smaller the amount of 
food you can eat in 24 hours. For example, if 
you used up all the 50 grams of carbohydrates 
in 3 per cent, vegetables, you could have had 
1667 grams, while if you used it all in 6 per 
cent, vegetables, you could have had 833 grams, 
or if you chose to eat your daily allowance of 
50 grams in 20 per cent, vegetables you would 
have had 250 grams. 

I have gone into tedious detail at the risk 
of wearying you in order that I may impress 
upon your mind the principle of estimating dia¬ 
betic foods, for without an accurate method of 
counting you will be sailing upon troubled 
waters and in time be dashed upon the diabetic 
rock of gangrene or submerged by the acid 
waves of coma. Diet is still the diabetic's com¬ 
pass pointing clearly the way for a safe voyage. 

So far, the counting is very simple, and you 
cannot make a mistake. Now I will show you 
a more difficult and more satisfactory way which 


METHOD OF ESTIMATING DIET. 61 

will enable you to eat some 3 per cent, vege¬ 
tables, peaches, or other 10 per cent, fruits, 
and also potatoes or other foods in the 20 per 
cent, group. You can do this and be in no dan¬ 
ger, truly eating the same amount of carbohy¬ 
drates as when you ate only the 1667 grams of 
3 per cent, vegetables, which we first counted. 

However, you must be very careful to make 
no mistake, for while a slight error upon the 
plus side in counting the 3 per cent, vegetables 
would make little difference, yet if you were 
counting 20 per cent, vegetables, the same slight 
error in calculation would result in your eating 
over six times as much carbohydrates as if the 
error were made in the 3 per cent, vegetables, 
and this might result seriously. 

We will continue to count for the same patient 
whose estimated tolerance of carbohydrates is 
50 grams daily and show you first how to divide 
his 50 grams among the 3 per cent., 6 per cent., 
and 20 per cent, foods. 

It is always best to estimate a part of the daily 
carbohydrates from the 10 per cent, fruits so 
you can have some fruit or berries for breakfast 
and dessert for the evening meal. (Grapefruit 
and strawberries, however, come under the 5 
per cent, fruits.) 


62 


DIABETES. 


Proceeding as follows, take 15 grams of car¬ 
bohydrates from the 3 per cent, list, hence, 
15 —5— 3 = 5; 5 X 100 = 500 grams of 3 per cent, 
foods; then, 15 grams from the 6 per cent, list, 
i 5-f-6 = 2.5; 2.5 X 100 = 250 grams of the 6 
per cent, foods. We have now used 15 and 15 
or 30 grams of the carbohydrates and there is 
left from the 50 grams, 20 grams of carbohy¬ 
drates to be taken from the 20 per cent, group. 
20 ■ 4 - 20 = 1; 1 X 100=100, i.e. 100 grams of 
any of the 20 per cent, foods. So the total daily 
allowance of carbohydrates would be: 

500 grams of any of the 3 per cent, foods 
250 grams of any of the 6 per cent, foods 
100 grams of any of the 20 per cent, foods 

The balance of the total daily allowance of 
protein and fat cannot be counted by the per 
cent, method as we have just done with the car¬ 
bohydrates, because most foods containing fat 
also contain protein in a different amount per 
100 grams. The vegetables and fruits contain 
no fat, but a small amount of protein, which 
has not been estimated in the preceding calcu¬ 
lations, but in the following table the estima¬ 
tion of protein in these foods will be included. 

We have taken carbohydrates first because 
they are the most important element of a dia- 


METHOD OF ESTIMATING DIET. 


63 


betic’s food, and next fats, because its rank is 
second in importance. 

The chief foods used to supply fats are butter, . 
cream, oils, bacon, cheese and nuts. 


3 per cent, veg. 

500 Gm. 

Protein 60. 

Protein. 

8 

Fats 150. 

Fat. 

Carbohydrates 

50. 

Carbohydrates. 

15 Gm. 

6 per cent. “ .... 

250 “ 

4 

— 

15 “ 

20 per cent. “ 

100 “ 

2 

— 

20 “ 

Butter . 

100 “ 

— 

80 

it 

2 eggs . 


12 

12 

it 

Cream (20 per cent.) 

50 “ 

2 

10 

2 “ 

Bacon . 

50 “ 

5 

33 

it 

Cooked lean meat ... 

100 “ 

26 

15 

it 

Total .., 


59 

150 

52 


In the above daily schedule we have first 
taken 

500 grams of 3 per cent, vegetables with a carbo¬ 
hydrate value of 15 grams and a protein value 
of 8 grams. 

following: 

250 grams of 6 per cent, foods with a carbohy¬ 
drate value of 15 grams and a protein value 
of 4 grams. 

100 grams of 20 per cent, foods with a carbohy¬ 
drate value of 20 grams and a protein value 
of 2 grams. 

100 grams of butter containing 80 grams of fat. 

Eggs (2) protein value of 12 grams and 12 grams 
of fat. 







64 


DIABETES. 


50 grams of 20 per cent, cream; 2 grams of pro¬ 
tein; 10 grams of fat; 2 grams of carbohy¬ 
drate. 

50 grams of bacon; 5 grams of protein; 33 grams 
of fat. 

While you are deciding upon the amounts of 
butter, eggs, cream, etc., that are to be included 
in the total daily allowance, you should keep 
adding the amount of protein and fat in these 
various foods and subtracting it from the total 
daily allowance in order that you will not ex¬ 
ceed this amount. 

Unless you are an accountant or have recently 
finished school, it would be better to proceed 
as follows: 

Total allowance in protein, 6o; fat, 150; car¬ 
bohydrates, 50. Protein and carbohydrates al- 


ready estimated by method: 

Protein. 

Fat. 

Carbohydrates. 

Vegetables and fruits . 

14 

— 

50 

Butter . 

0 

80 

— 

Eggs ( 2 ) . 

12 

12 

— 

Cream (20 per cent.) . 

2 

10 

2 

Bacon . 

5 

33 

— 

Lean meat cooked. 

26 

15 

— 

Total. 

59 

150 

52 


Each time that you add food, be sure that the 
total of protein and fat does not exceed your 
total daily allowance given at the top of the 









METHOD OF ESTIMATING DIET. 65 

table. If you preferred olive oil or cheese, in¬ 
stead of some of the butter, cream or bacon, 
they could be substituted wholly or in part, re¬ 
placing some of the above, and their special 
food value is to be estimated after consulting 
the table of food contents in the same way as 
you did with the other foods. 


5 


CHAPTER V. 


HOW TO TEST THE URINE FOR 
GLUCOSE (SUGAR). 

There is only one laboratory test that the 
diabetic patient must learn in order to assist his 
physician in keeping his disease properly con¬ 
trolled after he leaves the hospital; that is, 
testing the urine for sugar. Benedict’s solution 
is the best to use in this test and one which any 
good druggist can make. The formula for this 
solution is: 


Copper sulphate (pure crystallized) . 17.3 Gms. or c.c. 

Sodium or potassium citrate. 173.0 “ “ “ 

Sodium carbonate (crystallized) . 200.0 “ “ “ 

(one-half the weight of the anhydrous salt 
may be used.) 

Distilled water to make . 1000.0, “ “ “ 


The citrate and carbonate are dissolved to¬ 
gether (with the aid of heat) in about 700 cubic 
centimeters of water. The mixture is then 
poured (through a filter if necessary), into a 
larger beaker or casserole. The copper sulphate 
(which should be dissolved separately in about 
100 cubic centimeters of water) is then poured 
slowly into the first solution, with constant stir- 
( 66 ) 






TESTING URINE FOR GLUCOSE. 6 7 

ring. The mixture is then cooled and diluted 
to one liter. This solution keeps indefinitely. 

A few of my patients have occasionally pur¬ 
chased improperly made solutions. The solution 
if not correctly made can be detected by the fol¬ 
lowing simple tests: 

First.—It should be blue in color and so clear 
that you can read ordinary print through it 
when in a chemical test-tube. 

Second.—It should retain its blue color and 
clearness even after boiling. 

Third.—The addition of the smallest pinch of 
pure powdered glucose, which can be obtained 
at a drug store, to the boiling solution should 
immediately make it cloudy and turn the blue 
to green-yellow, orange or brick-red, depending 
upon the amount of glucose added. 

Each new bottle of Benedict’s solution which 
you purchase should respond to the above tests 
as indicated or you should not use it. 

DIRECTIONS FOR THE TEST. 

Put in a chemical test-tube about 5 mils of 
Benedict’s solution, adding to that 8 drops 
of urine. Have a little saucepan of water ready 
so that the tube can rest against the side of it, 
being careful, however, that the contents do not 
spill out. The water in the saucepan should 


68 


DIABETES. 


cover the tube at least to the point of the solu¬ 
tion in the tube. Bring the water to a boil and 
keep it boiling for at least three minutes. Then 
remove the tube from the water and allow it 
to cool. The solution should remain perfectly 
clear and blue if the urine is sugar-free. The 
frontispiece demonstrates the changes which oc¬ 
cur when there is sugar present in increasing 
amounts. 

The test which we have just described is called 
Benedict’s qualitative test for glucose in the 
urine as distinguished from Benedict’s quanti¬ 
tative test which, of course, is used to estimate 
the amount of sugar in the urine. To the 
amount you need give no attention, for the 
presence of even the slightest trace of sugar in 
the urine of a diabetic patient is a danger signal 
to him, and should be as promptly regarded as 
a small fire in the waste basket or in the cur¬ 
tains in his home, demanding immediate atten¬ 
tion if he does not wish the situation to spread 
beyond control. Immediate attention means 
consultation with your physician at once, for, 
as Doctor Allen says, “there is no real demar¬ 
cation either in theory or practice between the 
slightest diabetic cases and the extremely severe 
forms which reach their natural end in coma.” 


TESTING URINE FOR GLUCOSE. 


69 


It is not the “loss of sugar in the urine/’ but 
the poisons that develop from the excess of 
sugar in the body tissues which cause the weak¬ 
ness and other complications from which the 
improperly managed diabetic suffers. Only by 
testing your urine at least every other day can 
you truly consider yourself free from these 
dangers. 

I have not described the tests for acetone and 
diacetic acid in the urine because they are rather 
difficult to do accurately and acetone and diacetic 
acid are practically never present in dangerous 
amounts if the diabetic’s urine is sugar free. 


CHAPTER VI. 

INSULIN. 

The diabetic who has the severe type of the 
disease, owes his chance to live to Dr. Frederick 
G. Banting, the discoverer of insulin which is 
the active, internal secretion of the islands of 
Langerhans. 

Dr. Banting returned from the World War a 
real hero, and opened an office thoroughly 
equipped with the latest instruments to prac¬ 
tice his specialty, orthopedic surgery. 

His quiet, ethical or orthodox medical ways 
did not immediately attract a lucrative practice, 
so he obtained work in a physiological laboratory 
and was soon seeking the elusive insulin for 
which many scientists before him had earnestly 
searched. 

He reviewed their tests and then formed a 
theory of his own upon which he labored many 
months. His finances being exhausted, he sold 
his office equipment at a sacrifice that he might 
continue his labors. 

During his five years of war service he had 
been decorated for bravery and had had the 
stimulating thrill of high heroism. 

( 70 ) 


INSULIN. 


71 


This thrill of sacrifice still inspired him to 
labor for humanity and after many tedious trials 
he brought forth insulin. 

It is the beginning of a new epoch and the 
finger of medical history has already written 
this young man’s name in her book of ages. 
After Allen’s brilliant work on diet, we needed 
only insulin to place diabetes far above all other 
diseases in the scientific accuracy and mathe¬ 
matical exactness of its treatment. The dra¬ 
matic results when diabetic coma is properly 
treated with insulin entirely outrival the ablest 
efforts of our most skilful surgeons. In truth, 
it is almost bringing the dead back to life! 

However, in the scientific sense, insulin does 
not cure diabetes. Neither Dr. Banting nor 
those chosen to study it clinically so consider it. 
It is recognized as a help or an aid to those 
whose diabetes is of such severity that a care¬ 
ful regulation of diet will not keep them in good 
health and enable them to maintain their ef¬ 
ficiency. 

Insulin will not act when given by mouth and 
must be administered by hypodermic needle. In 
diabetic coma the first dose is occasionally in¬ 
jected into the vein but at all other times it 
must be injected under the skin. 


72 


DIABETES. 


The manufacture of insulin is controlled by 
the Insulin Committee of the Medical Depart¬ 
ment of the University of Toronto, and up to the 
present time they have given permission to the 
Connaught Laboratories of Toronto and Eli 
Lilly Co. of the U. S. A. to manufacture it, the 
latter firm manufacturing it under the trade 
name of Iletin. 

There are many “drug firms” selling a sub¬ 
stance in capsules or powders which is claimed 
to be “just as good as insulin,” or iletin, and 
that it can be given by mouth. These claims 
have not been substantiated by carefully con¬ 
trolled clinical tests or by animal experimenta¬ 
tion. I have personally purchased many of these 
“just as good as insulin” preparations in the open 
market and tried them out very carefully upon 
animals. Not one preparation that I tested was 
potent! Neither is there a drug, water, patent 
food or “adjustment” that ever convinced a real 
doctor, an M.D., that it had any favorable in¬ 
fluence upon the disease, diabetes. 

Insulin was not officially distributed to the 
general practitioner in the United States until 
November 15, 1923, but those of us who had 
been previously conducting well-organized dia¬ 
betic clinics were supplied with it from the be- 


INSULIN. 


73 


ginning of that year so that it could be thor¬ 
oughly tested out clinically and experimentally. 

This was a wise provision, for all those des¬ 
ignated to study insulin unanimously agree that 
a special knowledge of foods, or the so-called 
diabetic dieting, is one of the fundamentals es¬ 
sential for the physician who expects to use in¬ 
sulin successfully. It is also admitted that 
insulin has increased the difficulties for the doc¬ 
tor in the treatment of diabetes. 

I have advisedly placed my chapter on Insulin 
after the instructions on diet because, even in 
the most severe cases, diet is the foundation of 
“rebuilt” health. 

Insulin does not create a habit; i.e., it is not a 
narcotic nor a habit-forming drug. I have had 
many diabetics who required insulin for a long 
time, but now are regulated by diet alone. One 
case in particular, a physician who was on in¬ 
sulin treatment for several months, taking as 
high as 35 units a day, has not had a single 
unit of insulin for four months. He is in per¬ 
fect health; blood sugar normal and urine sugar- 
free all the time. He is sure that insulin is the 
sword that repulsed the enemy, but that diet is 
the fortress that still protects him. 

The dose of insulin varies with each case and 
is measured by units. A unit is the amount of 


74 


DIABETES. 


insulin required to reduce the blood sugar of a 
2 kilogram rabbit from normal to 45 mgs. in 
two hours. According to the severity of the 
diabetes, the dose varies from one or two units 
up to sixty units daily. 

TIME OF DOSES OF INSULIN. 

In diabetic coma as high as 50 units every 
hour or two for several hours may be required. 
All coma cases should be sent immediately to a 
hospital that has a good laboratory and a well- 
organized department of diabetes, as many dif¬ 
ficult procedures are involved in the treatment 
of the coma case if the patient is to have the 
best opportunity for recovery. 

Diabetics on insulin treatment at home require 
injections from one to four times daily accord¬ 
ing to the number of units of insulin that the 
patient must take to utilize his proper allowance 
of carbohydrates. The injections of insulin are 
usually given fifteen to thirty minutes before 
food is taken. 

HYPOGLYCEMIC REACTION. 

Insulin shock, as this is sometimes called, is 
a series of symptoms which a diabetic patient 
will experience if the dose of insulin is not prop¬ 
erly balanced with the carbohydrates consumed 


INSULIN. 


75 


in his food. These symptoms are nervousness, 
weakness, gnawing hunger, sweating and a men¬ 
tal state of vagueness to his surroundings. In¬ 
sulin shock is a real danger; but the nervous dia¬ 
betic is inclined to exaggerate the symptoms un¬ 
less he thoroughly understands them. It is 
caused by the reduction of the blood sugar be¬ 
low normal and is always accompanied by some 
of the symptoms mentioned. It is immediately 
relieved by eating a lump of sugar or an orange 
or other similar food. The diabetic who is tak¬ 
ing insulin should carry in his pocket a piece of 
candy or sugar, eating it at once if two or more 
of the symptoms as above described are felt. 
The next day a little before the hour when these 
symptoms occurred your physician will have a 
blood sugar estimation done which will tell 
positively whether your dose of insulin is too 
large. Of course, you should not take any in¬ 
sulin if you are not going to get your regular 
meal within one-half hour after the injection. 
If your supply of insulin is exhausted, your daily 
allowance of food should be reduced one-half un¬ 
til you resume your usual insulin dose. 

THE USUAL AILMENTS. 

When these are encountered such as colds, 
fevers, boils or infections of any kind, the 


76 


DIABETES. 


services of a physician are required at once, as 
the carbohydrate tolerance is lowered during 
even temporary or mild illnesses. Tell the 
physician of your diabetes, diet and insulin dos¬ 
age for the reason that adrenalin and a few 
other drugs which are prescribed for colds and 
fevers, raise blood sugar even in normal 
persons. 

The physician thoroughly understands all of 
the dangers of diabetes. When suspicious of 
acidosis or any other serious trouble, you are 
incomparably safer to send for your doctor at 
once instead of following self-treatment courses 
first, even if written by a physician, and calling 
the doctor later. Treatment is only guess-work 
without a correct diagnosis, so consult your 
physician freely and without loss of time if you 
fear trouble. 

SURGERY REQUIRING GENERAL ANESTHESIA. 

Should the diabetic develop any operative con¬ 
dition for the surgery of which a general anes¬ 
thesia would be required, insulin treatment must 
be instituted before the operation in order to 
bring the blood sugar to normal limits and is 
most especially necessary after operation. An 
anesthetic usually raises the blood sugar even in 
non-diabetics, so you can readily understand that 


INSULIN. 


77 


a patient must be most carefully and closely 
watched after an operation so that coma does 
not develop nor the healing of the wound be 
delayed. 

In his foreword to this little book, Professor 
John B. Deaver has explained the benefit of in¬ 
sulin treatment in the surgery of diabetes and 
has emphasized the importance of close co¬ 
operation between the internist and the surgeon. 

Finally, do not get nervous; do not worry; 
follow instructions carefully, remembering that 
dieting is not fasting and does not mean slow 
starvation but consists of the proper use of 
foods; adhere to your diet faithfully and your 
reward will be good health. 


CHAPTER VII. 


THE TECHNIQUE OF ADMINISTERING 
INSULIN AT HOME. 

SYRINGE AND NEEDLE. 

The ideal syringe for administering insulin is 
a glass “tuberculin” type of either one or one 
and one-half mil capacity. The blue plunger of 
the tuberculin syringe facilitates a more accur¬ 
ate estimation of the dosages of insulin than the 
ordinary type syringe. 

The most satisfactory needle is steel, twenty- 
five gauge, of three-quarter inch length. 

CARE OF SYRINGE AND NEEDLE. 

The syringe and needle should be boiled in 
water for five minutes, at least once during the 
day when insulin is taken. Before using the 
syringe at other times during the day, it is only 
necessary to fill it two or three times with medi¬ 
cated alcohol, and then with boiled water. 
After the needle has been cleaned be careful not 
to allow it to touch anything that is not satur¬ 
ated with alcohol, before giving the insulin. 
Your hands should be thoroughly washed before 
handling syringe or needle. 

( 78 ) 


ADMINISTERING INSULIN AT HOME. 79 


After giving the insulin, wash the syringe 
with alcohol, then dry the syringe and needle 
and put away until it is necessary to use them 
again. 



Fig. 6.—Filling syringe with insulin preparatory to mak¬ 
ing an injection. (From International Clinics. Courtesy of 
J. B. Lippincott Co., Publishers.) 


To aid in cleaning the syringe and needle, two 
vessels or bottles, holding 30 to 60 mils, should 
be kept, one to contain the alcohol and the other 
for the boiled water. These bottles should be 
sterilized from time to time by boiling for five 
minutes in water. 





80 


DIABETES. 


MEASURING THE INSULIN. 

As is mentioned above, the Luer “tuberculin” 
syringe is very good for the purpose. These 


syringes can 

be obtained 

in two sizes, of 

one 


1 UNIT uao 

UNITS UlO 




1 - ll^ lwlru, ° 

1 

Jt — 10 UNITS UZ( 

, ^)i o 0FA MIL 


CT 

111 so 


80 ‘ ! 1 mil 


' - 




ONE MIL 'SYRINGE 


Fig. 7. 

mil and one and one-half mil capacity. Each is 
graduated in two ways, in mils and in minims. 
The mil graduation is the best. On the one-mil 
syringe the graduation is divided into twenty 


^lUNir U20 f-S- UNITS UlO 

i, pj ** UNIT UIQ l— IO UNITS UZO fi% Q OF A MIL 


tF 
1 i 

1-4- 

1 1 I 1 1 1 II ll 1 II 

1 

1 1 1 1 1 1 1 1 1 

—1—4- 

i . lJ*cc 

i 1 i i i i L. 







-J 



ONE and ONE-HALF MIL 'SYRINGE 
Fig. 8. 


spaces, each representing one-twentieth of a mil. 
Each of these spaces is again divided into five 
smaller spaces, each representing one one-hun¬ 
dredth of a mil. The one and one-half mil syr¬ 
inge is divided into twenty spaces as is the 










ADMINISTERING INSULIN AT HOME. 81 

other, but it is not divided into hundredths. 
When holding the syringe in the right hand hori¬ 
zontally, with the graduations toward you and 
the needle end toward the left, the upper gradua¬ 
tion is the mil and the lower is the minim 
graduation, which latter should not be used. 

Insulin is measured by units, each unit being 
an amount which has a definite physiological 
strength. It is made in two potencies, one hav¬ 
ing ten units in each mil and the other having 
twenty units in each mil, the former being half 
as strong as the latter. They are designated 
as U-io and U-20, respectively. Thus, it is 
easily seen that to measure out ten units of U-10 
it is necessary to fill the syringe to the one mil 
mark, and ten units of U-20 to the one-half mil 
mark. In order to measure an odd number of 
units it is only necessary to understand what 
is equal on the syringe to a twentieth of a mil 
(see diagram). Each of these spaces is equal 
to one unit of U-20 and to one-half of a unit of 
U-10. So that four units on the one-mil syringe 
would be to the line marked “20,” and on the 
one and one-half mil syringe it would be four- 
tenths of the distance to the one-half mark. 


6 


82 


DIABETES. 


FILLING THE SYRINGE. 

The syringe and needle have been cleaned 
and the amount of insulin to be taken has been 
decided. Then the plunger of the syringe is 
withdrawn to the mark indicating the desired 
amount of insulin. Insulin is sold in small glass 
bottles, sealed with a rubber stopper, containing 
five mils of a known strength, either U-io or 
U-20. 

To prepare the bottle before using, insert the 
rubber-stoppered end into medicated alcohol. 

Now, with the plunger withdrawn to the de¬ 
sired mark, puncture the rubber stopper with the 
needle and press the plunger in completely, thus 
expressing the air contained in the syringe into 
the bottle. In this way enough air is injected 
into the bottle to replace the amount of insulin 
removed, thereby making easier the removal of 
the insulin. 

Next, hold the insulin bottle so that the in¬ 
sulin accumulates at the stoppered end of the 
bottle, i.e., upside down. Gradually withdraw 
the plunger with the other hand to the mark 
indicating the proper amount of insulin. If, in 
withdrawing the plunger, a small air bubble 
has accumulated at the needle end of the syr¬ 
inge, just withdraw the syringe plunger one or 


ADMINISTERING INSULIN AT HOME. 83 

two spaces past the proper one and then return 
plunger to the proper division, which expresses 
the air into the insulin bottle. 

Now, place the index finger of the hand hold¬ 
ing the syringe upon the needle and extract both 
the syringe and needle at the same time from 
the bottle. Then the insulin is given as described 
below. 

In handling the syringe while filled with in¬ 
sulin it is best to do so by means of the barrel 
and not the plunger, otherwise the plunger may 
be touched and some of the insulin will be ex¬ 
pressed and lost. 


INJECTION. 

Now that the syringe is filled with the proper 
amount of insulin it is ready to be injected. 

The skin at the place of proposed injection is 
first prepared by washing with soap and water, 
followed by medicated alcohol. It can be in¬ 
jected into the fleshy part of the arm above the 
elbow or into the fleshy part of the thigh. The 
arm below the elbow or the leg below the knee 
should not be used. Insulin is injected under 
the skin, but not into the muscle. This is done 
by taking the skin between the thumb and in¬ 
dex finger, lifting the skin up and inserting the 
needle through the elevated skin at not too great 


84 


DIABETES. 


an angle. The plunger is then pushed down un¬ 
til all the fluid is expelled. In withdrawing the 
needle it is best to apply pressure over the 
needle and surrounding skin with a small piece 
of cotton saturated with alcohol while the 
needle is being withdrawn. 


CHAPTER VIII. 

SAMPLE MENUS. 

The Bulk of the Carbohydrate Portion Varying 
with the Desire of the Patient, Protein 
and Fat Remaining Constant. 

The following tables of large, medium and 
small bulk diets are sample diets, arranged so 
that each contains the same number of total 
calories, yet the amount or bulk of food varies. 
Diabetics taking insulin must consume approxi¬ 
mately the same number of calories daily, being 
especially careful to eat the daily allowance of 
carbohydrates, but the bulk of foods consumed 
can be changed as indicated in the tables below. 
The bulk of proteins and fats cannot be changed 
without giving a marked variation in total cal¬ 
ories, hence these remain constant in the sample 
diets, but the carbohydrates can be changed as 
indicated to suit the temporary variations of the 
individual patient, especially those brought on 
by diarrhea, colds, acute infections, etc. The 
sample small bulk diet can be made much 
smaller, yet the total calories remain the same, 
by using only 20 per cent, vegetables or, by the 

(85) 


86 


DIABETES. 


direction of the physician, eating only toast for 
the daily portion of carbohydrate. 


IDEAL DIABETIC WEIGHT 110 LBS. 


Amt. 

Daily food allowance 

Prot. 

Fat. 

Carb. 


1646 cal. 

55 

138 

46 


Coffee . 

0 

0 

0 

90 

Cream, 20 per cent. 

3 

18 

3 

2 

Muffins . 

17 

12 

0 

47 

Butter. 

0 

40 

0 

1 

Egg... 

6 

6 

0 

113 

Meat—fish. 

23 

17 

0 

30 

Bacon . 

5 

15 

0 

30 

Olive oil . 

0 

30 

0 


300 

Large Bulk Diet, Carbohydrate Portion. 

Fruit, 5 per cent. 0 0 

15 

633 

Vegetables, 3 per cent. 

.. 0 

0 

19 

150 

Vegetables, 6 per cent. 

.. 0 

0 

9 


Total. 

.. 54 

138 

46 

Medium Bulk Diet, 

Carbohydrate Portion. 

Amt. 


Prot. 

Fat. 

Carb. 

100 

Fruit, 5 per cent. ... 

.. 0 

0 

5 

100 

Fruit, 10 per cent. 

.. 0 

0 

10 

400 

Vegetables, 3 per cent. 

0 

0 

12 

150 

Vegetables, 6 per cent. 

.. 0 

0 

9 

50 

Vegetables, 15 per cent. 

.. 0 

0 

7.5 

Amt. 

Small Bulk Diet, Carbohydrate 

Prot. 

Portion. 

Fat. 

Carb. 

100 

Fruit, 15 per cent. ... 

.. 0 

0 

15 

100 

Vegetables, 6 per cent. 

.. 0 

0 

6 

50 

Vegetables, 15 per cent. 

.. 0 

0 

7.5 

75 

Vegetables, 20 per cent. 

.. 0 

0 

15 


















SAMPLE MENUS. 


87 


IDEAL DIABETIC WEIGHT 120 LBS. 


Amt. 

Daily food allowance 

Prot. 

Fat. 

Carb. 


1790 cal. 

60 

150 

50 


Coffee . 

0 

0 

0 

90 

Cream, 20 per cent. 

3 

18 

3 

1139 m 

Meat—fish . 

23 

179 m 

0 

2 

Eggs . 

12 

12 

0 

30 

Bacon . 

5 

15 

0 

549 m 

Butter. 

0 

469 m 

0 

2 

Muffins . 

17 

12 

0 

30 

Olive oil . 

0 

30 

0 


Large Bulk Diet, Carbohydrate Portion. 


700 

Vegetables, 3 per cent. . 

. 0 

0 

21 

100 

Vegetables, 6 per cent. . 

. 0 

0 

6 

400 

Fruit, 5 per cent. 

. 0 

0 

20 


Total. 

. 60 

150 

50 


Medium Bulk Diet, Carbohydrate Portion. 


Amt. 

200 

Vegetables, 3 per cent. .. 

Prot. 

0 

Fat. 

0 

Carb. 

6 

200 

Vegetables, 6 per cent. .. 

0 

0 

12 

100 

Fruit, 10 per cent. 

0 

0 

10 

100 

Fruit, 5 per cent. 

0 

0 

5 

92 

Vegetables, 15 per cent. .. 

0 

0 

14 


Small Bulk Diet, Carbohydrate Portion. 


Amt. 


Prot. 

Fat. 

Carb. 

100 

Vegetables, 6 per cent. .. 

0 

0 

6 

50 

Vegetables, 15 per cent. ., 

0 

0 

7.5 

92 

Vegetables, 20 per cent. .. 

0 

0 

18.5 

100 

Fruit, 15 per cent. 

0 

0 

15 















DIABETES. 


IDEAL DIABETIC WEIGHT 140 LBS. 


Amt. 

Daily food allowance 

Prot. 

Fat. 

Carb. 


2109 cal. 

70 

177 

59 


Coffee . 

0 

0 

0 

150 

Cream, 20 per cent. 

3 

30 

5 

659 m Butter . 

0 

559 m 

0 

2 

Eggs . 

12 

12 

0 

30 

Bacon . 

5 

15 

0 

1139 m Meat—fish.•. 

23 

179 m 

0 

3 

Muffins . 

25.5 

18 

0 

30 

Olive oil . 

0 

30 

0 


Large Bulk Diet, Carbohydrate Portion. 


15 

Oatmeal (dry) . 

2.5 

1 

10 

50 

Fruit, 10 per cent. 

0 

0 

5 

200 

Fruit, 5 per cent. 

0 

0 

10 

200 

Vegetables, 6 per cent. .. 

0 

0 

12 

566 

Vegetables, 3 per cent. .. 

0 

0 

17 


Total. 

71 

178 

59 

Medium Bulk Diet, Carbohydrate Portion. 

Amt. 


Prot. 

Fat. 

Carb. 

15 

Oatmeal (dry) . 

2.5 

1 

10 

100 

Fruit, 10 per cent. 

0 

0 

10 

100 

Fruit, 5 per cent. 

0 

0 

5 

300 

Vegetables, 3 per cent. .. 

0 

0 

9 

200 

Vegetables, 6 per cent. .. 

0 

0 

12 

50 

Vegetables, 15 per cent. .. 

0 

0 

7.5 


Small Bulk Diet, Carbohydrate 

Portion. 


Amt. 


Prot. 

Fat. 

Carb. 

15 

Oatmeal (dry) . 

2.5 

1 

10 

150 

Fruit, 10 per cent. 

0 

0 

15 

166 

Vegetables, 3 per cent. .. 

0 

0 

5 

150 

Vegetables, 6 per cent. .. 

0 

0 

9 

75 

Vegetables, 20 per cent. .. 

0 

0 

15 





















DIET BLANK 


Date--- M f a l Breakfast 

Name—— D -. w - 120 Med. B ulk Ward _ Room 

DAILY FOOD PROPORTIONS. 


60 P. 150 F. 50 C. 1790 CAL. 


AMT. 


P. 

F. 

C. 


Vegetables, 3 per cent.*.. 





Vegetables, 6 per cent. .. 





Veg. or fruit, 15 per cent. 





Veg. or fruit, 20 per cent. 




100 

Fruit 5 per cent. 

0 

0 

5 


Fruit, 10 per cent. 





Meat or fish . 




30 

Cream 20 per cent. 

1 

6 

1 

549 m 

Butter . 

0 

469 m 

0 

2 

Eggs . 

12 

12 

0 

30 

Bacon . 

5 

15 

0 

1 

Lister Muffins . 

8.5 

6 

0 


Coffee . 

0 

0 

0 

















Total. 

26.5 

85 

6 



Total 

Calories 

895 


( 89 ) 
















































DIET BLANK 


Date 


Meal 


Dinner 


Name L D ’ W ~ 120 Med ~ Bulk ■ Ward- Room 

DAILY FOOD PROPORTIONS. 


P. F. C. CAL. 


AMT. 


P. 

F. 

C. 

50 

Vegetables, 3 per cent. .. 

0 

0 

15 

100 

Vegetables, 6 per cent. .. 

0 

0 

6 

92 

Veg. or fruit, 15 per cent. 

0 

0 

14 


Veg. or fruit, 20 per cent. 





Fruit, 5 per cent. 




100 

Fruit, 10 per cent. 

0 

0 

10 

70 

Meat or fish . 

14 

9 

0 

30 

Cream, 20 per cent. 

1 

6 

1 


Butter. 





Eggs . 





Bacon . 





Lister muffins . 





Coffee . 

0 

0 

0 














. 


Total. 

15 

15 

32.5 



Total Calories | 325 


( 90 ) 

















































DIET BLANK 


Date- Meal_ Supper _ 

Name— 1 - D - w ~ 120 Med - Bulk Ward- Room- 

DAILY FOOD PROPORTIONS. 


P. F. C. CAL. 


AMT. 


P. 

F. 

C. 

150 

Vegetables, 3 per cent. .. 

0 

0 

4.5 

100 

Vegetables, 6 per cent. .. 

0 

0 

6 


Veg. or fruit, 15 per cent. 





Veg. or fruit, 20 per cent. 





Fruit, 5 per cent. 





Fruit, 10 per cent. 




45 

Meat or Fish . 

9 

6 

0 

30 

Cream 20 per cent. 

1 

6 

1 


Butter. 





Eggs . 





Bacon . 




1 

Lister muffins . 

8.5 

6 

0 


Coffee . 

0 

0 

0 

30 

Olive oil . 

0 

30 

0 












Total. 

18.5 

48 

11.5 



Total Calories 

j 552 


( 91 ) 
























































CHAPTER IX. 

RECIPES. 


MAYONNAISE 

DRESSING. 



Prot. 

Fat. Carb. 

Yolk of one (1) egg. 

1.6 

3.3 

0 

30 Gms. olive oil. 

0 

30 

0 

10 c.c. lemon juice . 

0 

0 

1 

Salt, pepper and paprika . 

0 

0 

0 


1.6 

33.3 

1 

Mix dry ingredients and add oil 

and lemon 

juice 


very slowly. 

TOMATO SURPRISE. 

Prot. Fat. Carb. 

60 Gms. chicken . 16 6 0 

75 Gms. tomato 
25 Gms. lettuce 
20 Gms. celery 

16 6 3.6 

Skin tomato and cut out a large enough portion in 
which to place the chicken and celery, which is 
mixed with mayonnaise and seasoned. Place tomato 
on lettuce. 

IRISH STEW. 

Prot. 

60 Gms. Meat . 16 

100 Gms. tomatoes . 0 

100 Gms. carrots £ n 

100 Gms. onions j 

Salt and pepper. 0 

16 

Cook meat and vegetables together and season. 

( 92 ) 


Fat. Carb. 

10 0 

0 3 

0 6 

0 0 

10 9 













RECIPES. 


93 


SCALLOPED POTATOES. 



Prot. 

Fat. 

Carb. 

50 Gms. potatoes. 

. 0 

0 

10 

90 Gms. milk . 

. 3 

3 

4.5 

15 Gms. butter. 

. 0 

12 

0 


3 

15 

14.5 


Slice potato into very thin pieces, season with salt 
and pepper, pour milk over potatoes and sprinkle 
lightly with Lister’s diabetic flour. 


MUFFINS. 



Prot. 

Fat. 

Carb. 

1 box of Lister’s diab. flour .. 

.. 40 

0 

0 

2 eggs . 


12 

0 

30 Gms. butter . 

.. 0 

25 

0 


52 

37 equals 6 muffins 


Sift flour, then cream in the butter. Next beat the 
eggs (whites and yolks separately) and add to above 
mixture. Place in muffin tins and bake in medium 
oven for twenty minutes. 


CHICKEN SUPREME. 

Prot. Fat. 

SO Gms. chicken . 12 5 

1 egg . 6 6 

60 Gms. milk . 2 2 

33 Gms. celery. 0 0 


Carb. 

0 

0 

3 

1 


20 13 4 

Beat egg, add chicken and celery cut in small pieces, 
also milk, salt and pepper. Put in mould, set in pan 
of hot water and bake in moderate oven until firm. 











94 


DIABETES. 


BAKED SQUASH. 




Prot. 

Fat. Carb. 

100 Gms. squash . 


.... 0 

0 

3 

1 egg. 


.... 6 

6 

0 

30 Gms. cream . 


1 

6 

1 

Salt and pepper _ 


0 

0 

0 



7 

12 

4 

Beat egg, add mashed squash and cream and 

bake 

in moderately hot oven 

until firm. 




BAKED ONIONS. 





Prot. 

Fat. Carb. 

100 Gm<5 nnirm 


0 

0 

6 

30 Gms. meat, ground, lean 

and 


cooked . 


.... 8 

5 

0 

30 mils milk . 


.... 1 

1 

1.5 



9 

6 

7.5 

Parboil onion, 

scrape 

out the inside 

, leaving only 

shell, weigh shell 

and scrapings to 10C 

1 grams. 

Add 

meat to scrapings and return to shell. 

Place in 

cas- 

serole, add milk 

and bake until tender. 



MACARONI, CHEESE AND TOMATO. 



Prot. Fat. 

Carb. 

50 Gms. macaroni . 

. 0 0 

10 

100 Gms. tomato .., 

. 0 0 

3 

30 Gms. cheese .. 

. 8 11 

0 

10 Gms. butter- 

. 0 8 

0 


8 19 

13 

Boil macaroni. 

, then add cheese, tomato and butter 

and seasoning. 

Bake in oven until brown. 














RECIPES. 


95 


MACARONI, CHEESE AND CREAM. 



Prot. 

Fat. 

Carb. 

50 Gms. macaroni .. 

. 0 

0 

10 

30 Gms. cheese .. 

. 8 

11 

0 

60 Gms. cream. 

. 2 

12 

2 

10 Gms. butter.. 

. 0 

8 

0 

Salt and pepper .. 

. 0 

0 

0 


10 

31 

12 


Boil macaroni, add cheese, cream and butter. Bake 
until brown. 

BAKED EGGS. 

Prot, Fat. Carb. 

1 egg . 6 6 0 

Butter dish with small amount of butter from day’s 
allowance. Break egg in dish and place in pan of hot 
water. Place in oven until egg is formed. Serve 
immediately. 

STUFFED EGGS. 

Prot. Fat. Carb. 

2 eggs. 12 12 0 

Boil two eggs until hard, remove shell, cut in half 
and remove yolk. Mash yolks of eggs, add small 
amount of mayonnaise, salt and pepper. Put back 
in whites of egg and sprinkle with paprika. 


BAKED EGGPLANT. 

Prot. Fat. 

200 Gms. eggplant . 0 0 

1 egg. 6 6 


Carb. 

6 

0 


6 6 6 

Boil eggplant until soft, then mix with beaten egg, 
season, place in mold and bake until brown. 











96 


DIABETES. 


BAKED POTATO. 



Prot. 

Fat. 

Carb. 

100 Gms. potato. 

. 0 

0 

20 

15 Gms. butter . 

. 0 

12.5 

0 

Salt and paprika. 

. 0 

0 

0 


0 

12.5 

20 


Bake potato, cut in half and remove potato from 
shell; mix potato with butter, season, place again in 
shell, sprinkle with paprika. Put in oven for a few 
moments until brown. 


STUFFED TOMATO. 



Prot. 

Fat. 

Carb. 

100 Gms. tomato. 

. 0 

0 

3 

16 Gms. onion . 

. 0 

0 

1 

60 Gms. meat . 

. 16 

10 

0 


16 

10 

4 


Cut out center of tomato and fill with the meat and 
onion (ground), season. Bake in moderately hot oven. 


BAKED SPINACH. 

Prot 

100 Gms. spinach . 0 

1 egg. 6 

15 Gms. butter . 0 

6 18.5 3 

Boil spinach and weigh 100 grams, chop fine, mix 
with egg and butter and seasoning. Bake in oven 
until firm. 


Fat. Carb. 

0 3 

6 0 

12.5 0 











RECIPES. 


97 


HAM OMELET. 

Cut ham in small pieces, fry until a golden brown. 
Beat two eggs (whites and yolks separately), mix, 
season, pour over ham and cook until firm. 


OYSTER STEW. 

Prot. Fat. 

6 oysters . 6 1 

30 Gms. cream . 1 6 


Carb. 

4 

1 


7 7 5 


FRIED OYSTERS. 

Prot. Fat. 

6 oysters . 6 1 

1 egg . 6 6 

30 Gms. butter . 0 25 


Carb. 

4 

0 

0 


12 32 4 

Beat egg and mix with small amount of mustard, 
salt and pepper. Dry oysters, dip in mixture and fry 
in butter until brown. 


CODFISH BALLS. 

Prot. Fat. Carb. 


90 Gms. fish . 18 0 0 

50 Gms. potato . 0 0 10 

1 egg . 6 6 0 

30 Gms. lard . 0 30 0 


24 36 10 

Soak fish over night, then chop fine; boil potato and 
mash; mix while hot with fish and beaten egg, salt 
and pepper and paprika. Make into cakes and fry 
in hot lard. 


7 











98 


DIABETES. 


HAM SUPREME. 



Prot. 

Fat. 

Carb. 

90 Gms. ham . 

. 24 

15 

0 

90 Gms. milk . 

. 3 

3 

4.5 


— 

— 

— 


27 

18 

4.5 

Place thick ham 

in deep dish, cover with milk and 

return lid and put : 

in moderate oven 

until done. 

Then 

remove lid so that milk will be absorbed. 



CHOP SUEY. 

Prot. 

Fat. 

Carb. 

60 Gms. lean pork .. 

. 16 

10 

0 

33 Gms. celery . ) 

33 Gms. peppers ... 

. o 

0 

4 

33 Gms. mushrooms ) 

50 Gms. onions . 

. 0 

0 

3 

25 Gms. rice . 

. 0 

0 

5 


— 

— 



16 

10 

12 


Take lean pork and onion finely chopped, cut up 
mushrooms, celery and pepper and uncooked rice and 
1 y 2 cups of soup stock. Cook together fifty minutes 
and serve hot. 


CREAMED CUCUMBERS. 


100 Gms. cucumbers . 

Prot. 

. 0 

Fat. 

0 

Carb. 

3 

60 Gms. milk . 

. 2 

12 

2 

15 Gms. butter . 

. 0 

12.5 

0 


2 

24.5 

5 


Peel and slice cucumbers one-half inch thick; boil 
in salt water until tender. Dress in cream, butter and 
pepper. 












RECIPES. 


99 



SWISS STEAK. 

Prot. 

Fat. 

Carb. 

90 Gms. steak . 

. 24 

15 

0 

100 Gms. tomatoes 

100 Gms. celery .. v . 

. 0 

0 

3 

100 Gms. peppers ) 

50 Gms. onion . 

. 0 

0 

3 


— 

— 

— 


24 

15 

6 


Take thick piece of steak, salt and pepper, and fry 
until brown—an iron frying pan preferred; cover well 
with boiling water and vegetables cut fine and cover 
with lid. Cook slowly until vegetables are tender. 


BROILED SQUAB. 

Boned squab yields 50 grams of meat approxi¬ 
mately. Broil in oiled paper to prevent evaporation. 
It contains about 12 grams protein and 5 grams fat. 


CABBAGE SOUFFLE. 



Prot. 

Fat. 

Carb. 

100 Gms. cabbage . 

. 0 

0 

6 

1 egg . 

. 6 

6 

0 

30 Gms. cream. 

. 1 

6 

1 

30 Gms. cheese . 

. 8 

11 

0 

Salt and pepper . 

. 0 

0 

0 


15 

23 

7 


Chop cabbage fine, add cream and beaten egg with 
salt and pepper. Put into mould and sprinkle with 
grated cheese. Bake in moderate oven until firm and 
brown. 










100 


DIABETES. 


BROILED OYSTERS ON TOAST. 



Prot. 

Fat. 

Carb. 

6 oysters . 

. 6 

1 

4 

15 Gms. butter , 

. 0 

12.5 

0 

15 Gms. toast .. . 

. 1.5 

0 

9 

Salt and pepper 

. 0 

0 

0 


7.5 

13.5 

13 

Grease hot frying pan with small amount of butter; 

place oysters 

on heated surface and put on flame for 

two or three minutes until edges curl. 

Place toast on 

heated plate 

with oysters on toast 

and 

pour over 

heated butter. 

CHEESE BALLS. 




Prot. 

Fat. 

Carb. 

30 Gms. butter , 

. 0 

25 

0 

60 Gms. cheese . 

. 16 

22 

o . 

1 egg . 

. 6 

6 

0 

Salt and pepper 

. 0 

0 

0 


22 

53 

0 


Beat white and yolk of egg separately, fold grated 
cheese into egg, season and let stand for fifteen 
minutes. Make into balls the size of walnuts, fry in 
butter. 

BACON DRESSING. 

Prot. Fat. Carb. 

30 Gms. bacon . 5 15 0 

Small amount vinegar. 0 0 0 

5 15 0 

Chop bacon into very small pieces, fry light brown. 
Remove from fire, add vinegar and seasoning. Use 
for salad dressing. 












RECIPES. 


101 


TOMATO OMELET. 




Prot. 

Fat. 

Carb. 

100 Gms. egg albumen . 

. 26 

0 

0 

150 Gms. tomato . 

. 0 

0 

4.5 

Celery salt. 


0 

0 


26 

0 

4.5 


Beat albumen until dry and stiff; fold in the tomato, 
add celery salt or other seasoning as desired. Cook 
in large frying pan greased slightly with butter. 


ICE CREAM. 


120 mils cream 20 per 

cent. ... 

Prot. 

... 4 

Fat. 

24 

Carb. 

4 

100 Gms. 10 per cent. 

fruit ... 

... 0 

0 

10 

Pinch of salt . 


... 0 

0 

0 



4 

24 

14 


Wash fruit, mix with cream and freeze. Twice this 
quantity could be made and reckoned accordingly. 

ORANGE ICE. 

Prot. Fat. Carb. 

0 0 10 

0 0 0 

0 0 10 

Freeze. 

Salads—both fruit and vegetable—can easily be 
made and served attractively. 

Persons with severe cases of diabetes should be 
encouraged to take simple and natural foods. 


100 Gms. orange 
100 Gms. water 










102 


DIABETES. 


CRACKED COCOA. 


Cracked cocoa . 1 cup. 

Water. 1 quart. 


Add one cupful cracked cocoa to one quart of water 
and let simmer all day, adding water as needed to 
make one quart. 




CHAPTER X. 


THE PROTEIN, FAT AND CARBOHYDRATE 
CONTENT OF THE COMMONLY 
USED FOODS.* 


VEGETABLES. 


Three per cent. 

Asparagus, fresh or canned 

Cauliflower 

Celery 

Cucumber 

Eggplant 

Greens 

Leeks 

Lettuce 

Radishes 


(Carbohydrates). 

Rhubarb 

Sauerkraut 

Spinach 

Tomatoes, fresh or canned 
Canned artichokes 
Canned Brussels sprouts 
Canned string beans 
Canned okra 


Six per cent. (Carbohydrates). 


Beans, string, fresh 
Beets 

Curly cabbage and cabbage 

Carrots 

Collards 

Dandelion greens 
Mushrooms 


Okra 

Onions 

Rutabagas 

Squash, fresh or canned 
Turnips 

Canned green peas 
Canned pumpkin, and fresh 


* Selected from Bulletin No. 28, “The Chemical Composition of 
American Food Materials,” U. S. Department of Agriculture. 
This bulletin may be procured from the Supt. of Documents, 
Washington, D. C., for 10 cents. 


(103) 



104 


DIABETES. 


VEGETABLES ( continued ). 


Fifteen per cent. 
Artichokes, fresh 
Parsnips 
Green peas 

Twenty per cent. 
Fresh lima beans 
Green corn, fresh or 
canned 

Potatoes, sweet or Irish 

Thirty per cent. 
Butter beans 


(Carbohydrates). 

Canned lima beans 
Canned succotash 

(Carbohydrates). 

Boiled rice 

Canned baked beans, 7 
per cent, protein 
Canned kidney beans 

(Carbohydrates). 


FRUIT. 

Five per cent. (Carbohydrates). 
Strawberries Watermelon 

Grapefruit 


Ten per cent. (Carbohydrates). 
Blackberries Muskmelons 

Cranberries Oranges 

Currants Peaches 

Lemons Pineapples 


Fifteen per cent. (Carbohydrates). 


Apples Huckleberries 

Apricots Nectarines 

Cherries, without pits Pears 

Fresh figs Prunes 

Raspberries 


CONTENT OF COMMONLY USED FOODS. 105 

FRUIT ( continued ). 

Twenty per cent. (Carbohydrates). 

Bananas Pomegranates, without 

Grapes, without skins stones 

Prunes, without stones 

Miscellaneous Percentages (Carbohydrates). 
Persimmons, 30 per cent. 

Dried apricots, 60 per cent. 

All other dried fruits as: 


apples figs 

citron pears 

currants prunes 

dates raisins 

Barley, rye, whole wh< 

are 70 per cent, 
carbohydrate 

STARCHES. 

iat, rice, Prot. Fat. 

Carb. 

wheat, graham flour 



10 

0 

70 

Buckwheat flour . 



5 

0 

80 

Cornmeal . 



10 

0 

75 

Popcorn . 



10 

0 

75 

Oatmeal . 



15 

5 

65 

Rice. 



8 

0 

80 

Shredded wheat. 



10 

0 

78 

Brown, corn, rye, wheat, gluten, 
graham bread. 

8 

0 

50 

Graham and oyster crackers 
pretzels. 

and 

10 

8 

70 

Tapioca . 



0 

0 

88 

Cornstarch. 



0 

0 

90 

Milk, whole . 



3.5 

4 

5 

Milk, skimmed. 



3.5 

0.3 

5 

Milk, condensed, sweetened .. 


9 

8 

54 

Milk, condensed, unsweetened 


9 

9 

11 

Cream, 40 per cent. 



3.5 

40 

3.5 

Cream, 20 per cent. 



3.5 

20 

3.5 



















106 


DIABETES. 


VEGETABLES. 

Prot. 

Fat. 

Carb. 

(See special vegetable list). 
Beans, dried . 

. 22 

0 

60 

Beans, lima, dried . 

. 18 

0 

65 

Horseradish . 

. 0 

0 

10 

Lentils . 

. 25 

0 

60 

Olives, green . 

. 0 

25 

10 

Olives, ripe . 

. 0 

25 

5 

Peppers, green and red (dried) . 

. 10 

5 

70 

Canned sweet potatoes . 

. 0 

0 

40 

Tomato catsup . 

0 

0 

12 

MEAT. 

Prot. 

Fat. 

Carb. 

Beef, fresh. 

. 20 

15 

0 

“ boiled . 

. 26 

35 

0 

“ roast . 

. 22 

28 

0 

“ steak . 

. 25 

20 

0 

“ heart . 

. 16 

20 

0 

“ liver. 

. 20 

5 

0 

“ sweetbreads. 

. 16 

12 

0 

“ tongue. 

. 19 

9 

0 

“ corned, canned . 

. 26 

19 

0 

“ dried . 

. 40 

5 

0 

Veal . 

. 20 

6 

0 

Lamb . 

. 18 

20 

0 

Mutton . 

. 16 

21 

0 

Ham, fresh . 

. 15 

33 

0 

Pork chops . 

. 16 

32 

0 

Ham, fresh, visible fat removed . 

. 20 

16 

0 

Ham, smoked, fried . 

. 22 

33 

0 

Ham, smoked, boiled . 

. 20 

22 

0 

Bacon, smoked . 

. 10 

60 

0 

Sausage: 

“ bologna . 

. 18 

17 

0 

“ frank furt. 

. 19 

18 

0 

“ pork . 

. 15 

40 

0 































CONTENT OF COMMONLY USED FOODS. 107 


Chicken: 

MEAT ( continued ). 

Prot. 

Fat. 

Carb. 

“ broilers .. 

. 21 

3 

0 

“ fowls . . . . 

. 19 

16 

0 

Goose . 

. 16 

35 

0 

Turkeys . 

. 21 

22 

0 

Plover, roast. 

. 22 

10 

0 

Quail, canned. 

. 21 

8 

0 



FISH (Fresh). 

Prot. 

Fat. 

Carb, 

Black bass. 

. 20 

0 

0 

Catfish . 

. 14 

20 

0 

Codfish . 

. 16 

0 

0 

Flounder . 

. 14 

0 

0 

Haddock . 

. 17 

0 

0 

Halibut . 

. 18 

5 

0 

Herring . 

. 19 

5 

0 

Mackerel . 

. 19 

5 

0 

Mullet . 

. 19 

5 

0 

Muskellonge . 

. 20 

0 

0 

Perch . 

. 19 

0 

0 

Pickerel . 

. 18 

0 

0 

Pike . 

. 18 

0 

0 

Snapper . 

. 19 

0 

0 

Salmon . 

. 22 

12 

0 

Trout . 

. 19 

0 

0 

Weakfish . 

. 18 

0 

0 

Whitefish. 

. 22 

5 

0 



FISH (Canned). 

Prot. 

Fat. 

Carb. 

Cod, salt . 

. 25 

0 

0 

Haddock, smoked .. 

. 23 

0 

0 

Halibut, smoked ... 

. 20 

15 

0 

Herring, smoked ... 

. 36 

15 

0 

Mackerel, salt . 

. 20 

9 

0 

Salmon . 

. 21 

12 

0 

Sardines . 

. 23 

20 

0 

































108 


DIABETES. 


FISH, Canned 

( continued ) 




Prot. 

Fat. 

Carb. 

Caviar. 

30 

20 

0 

Tuna, canned in oil . 

23 

20 

0 

OTHER WATER FOODS. 



Prot- 

Fat. 

Carb. 

Frogs’ legs . 

15 

0 

0 

Clams . 

8 

0 

0 

Crabs, hard shell . 

16 

0 

0 

Lobster . 

16 

0 

0 

Mussels . 

9 

0 

0 

Oysters (six-average) . 

6 

1 

4 

Scallops . 

14 

0 

0 

Terrapin . 

20 

3.5 

0 

Turtle, green. 

20 

0 

0 

MISCELLANEOUS. 




Prot- 

Fat. 

Carb. 

Eggs (each) . 

6 

6 

0 

Butter. 

0 

85 

0 

Buttermilk. 

3 

5 

5 

Cheese. 

26 

36 

0 

Cheese, cottage . 

20 

0 

0 

NUTS. 




Prot. 

Fat. 

Carb. 

Almonds, beechnuts and Brazil .. 

20 

60 

10 

Butternuts . 

28 

60 

4 

Chestnuts . 

6 

5 

42 

Cocoanuts . 

6 

57 

31 

Cocoanut milk . 

0.4 

1.5 

4.6 

Filberts. 

15 

67 

11 

Lichi nuts . 

3 

0 

77 

Peanuts . 

25 

36 

24 

Peanut Gutter. 

30 

45 

20 

Pecans . 

10 

70 

15 

Walnuts, English . 

16 

63 

16 

Walnuts, black. 

27 

56 

11 





























INDEX 


Acid foods, 35 
Alkaline foods, 35 

Bacon dressing, 100 
Benedict’s solution, 66 
testing of, 67 
Blood in diabetes, 27 
normal, 26 
sugar, 26 

Cabbage souffle, 99 
Calorie, definition, 48 
diet low in, 42 
method of estimation, 53 
Carbohydrate, definition, 30 
per kilo body weight, 54 
c.c., 44 

Cellulose, definition, 34 
Cheese balls, 100 
Chicken supreme, 93 
Chop Suey, 98 
Cocoa, cracked, 102 
Codfish balls, 97 
Coma, insulin in, 71 
Constipation, treatment of, 34 
Cubic centimeter, 44 
Cucumber, creamed, 98 

Desserts, counting of, 61 
Diabetes, cause of, 16 
heredity, 17 
overeating, 17 


Diabetes, coma, 71 
common ailments in, 75 
cure of, 71 
definition, 13 
diagnosis of, 24 
laboratory tests, 25 
mild cases, 68 
operations in, 76 
Diet, blank sample, 89 
large bulk, 87 
medium bulk, 87 
small bulk, 87 
Diets, sample, 85 
Ductless gland deficiency, 18 

Eggplant, baked, 95 
Eggs, baked, 95 
stuffed, 95 

Fat, definition, 30 
per kilo body weight, 54 
source of, 63 
Fish, content of, 107 
Foods, acid, 35 
alkaline, 35 
body building, 30 
fatty acids in, 56-57 
fuel value, 21 

how to weigh and measure, 

43 

kind for diabetics, 49 
method of counting diabetics, 
55 


(109) 




110 


INDEX. 


Foods, short method, 64 
proportion for health, 30 
scales, 45 

scientific analysis, 27 
total daily amount, 63 
Fruits, carbohydrate content, 
104 

Glucose to fatty acid ratio, 56 
Gram, 44 

Ham supreme, 98 
Heredity, 16 

High blood-pressure, diet in, 38 
Hypoglycemic reaction, 74 
treatment, 74 

Ice cream, 101 
Iletin, 72 
Insulin, 70 
in coma, 71 
discovery of, 70 
dose of, 73 
filling of syringe, 79 
how to measure dose, 80 
how given, 78 
injection of, 83 
not a narcotic, 73 
preparations as good as, 72 
secretion of, 15 
shock, treatment, 74 
Irish stew, 92 
Islands of Langerhans, 15 

Kilo, 45 

Liquids, how to measure, 48 

Macaroni, cheese and tomato, 
94 


Macaroni, cheese and cream, 
95 

Mayonnaise dressing, 92 

Meals, method of counting, 59 

Meat, 106 

Menus, sample, 85 

Metric system, 43 

Mil, 44 

Mineral requirement in foods, 
31 

Muffins, 93 

Nuts, 108 

Obesity, 18 
Bright’s disease in, 20 
causes of, 18 
tables on, 19 
Omelet, ham, 97 
tomato, 107 
Onions, baked, 94 
Operations on diabetics, 76 
Orange ice, 101 
Overeating, 17 
Overweight and disease, 18 
Oysters, broiled, 100 
fried, 97 
stew, 97 

Pancreas, functions of, 15 
location of, 15 
secretions of, 15 
size of, 15 

Pancreatitis, definition of, 16 
Percentage method in counting 
foods, 50 
Potato, baked, 96 
Potatoes, scalloped, 93 



INDEX. 


Ill 


Protein, amount per kilo of 
body weight, 53 
definition of, 30 

Recipes, 92 
Renal diabetes, 27 
how diagnosed, 27 
glycosuria, 27 
threshold, 27 

Salt free diet, 38 

tables of, 38, 39, 40 
Scales, food, 45 
Spinach, baked, 96 
Squab, broiled, 99 
Squash, baked, 94 
Starches, 105 
Steak, Swiss, 99 
Sugar in urine, test for, 67 
tolerance, test for, 25 
Surgery, diabetes, 76 


Sweetbread, 14 
Syringe, care of, 78 

Tomato omelet, 107 
stuffed, 96 
surprise, 92 

Underweight, tables on, 20 
Uric acid, 35 
Urine, sugar in, 66 
test for sugar in, 67 

Value of foods, 21 
Vegetables, carbohydrate con¬ 
tent, 103 

Vitamins, 31, 32, 33 

Water, daily amount of, 34 
Weight, ideal, table of, 51 
normal, standard of, 20 




















































































































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